Healthcare Provider Details

I. General information

NPI: 1750357935
Provider Name (Legal Business Name): CAROLINE MARIE HATALA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE AIEMIAN

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CLINTON ST NEW HAMPSHIRE HOSPITAL
CONCORD NH
03301-2359
US

IV. Provider business mailing address

36 CLINTON ST NEW HAMPSHIRE HOSPITAL
CONCORD NH
03301-2359
US

V. Phone/Fax

Practice location:
  • Phone: 603-271-5464
  • Fax:
Mailing address:
  • Phone: 603-271-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number861
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: