Healthcare Provider Details

I. General information

NPI: 1043985708
Provider Name (Legal Business Name): MR. WILLIAM ALAN HARDIE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHEAST FAMILY SERVICES 55 PROVIDENCE HIGHWAY
NORWOOD MA
02062-0026
US

IV. Provider business mailing address

131 BOWDOIN ST
SPRINGFIELD MA
01109-4050
US

V. Phone/Fax

Practice location:
  • Phone: 774-206-1125
  • Fax: 774-628-9657
Mailing address:
  • Phone: 413-276-9987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: