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General NPI Number Information
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NPI Number | 1639751274
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Entity Type | Individual
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Provider Name | LAURA ANNE HACKIMER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 7022 RIDGE BLVD APT E7
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City | BROOKLYN
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State | NY
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Zip | 11209-1220
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Country | US
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Telephone | 516-581-5778
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Fax |
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Provider Business Mailing Address
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Address Line | 269 WHITTIER AVE
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City | FLORAL PARK
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State | NY
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Zip | 11001-1203
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Country | US
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Telephone | 516-581-5778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 023091
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License Number State | NY
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