MEDICARE: MS. AMY HADLEY LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1019508	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PO6114	OTHER	MA	BLUE CROSS BLUE SHIELD
2	PO6114	OTHER	MA	MEDEX

General Provider Information

NPI Number	:	1174675284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY HADLEY LICSW

Provider Business Mailing Address
First Line	:	1234 BROADWAY
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02144-1703
Country	:	US
Telephone Number	:	857-998-0747
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 BROADWAY
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02144-1703
Country	:	US
Telephone Number	:	857-998-0747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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