Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC010952 | PA |
NPI | 1003465048 |
---|---|
Provider Name | Benjamin Hindle Hazen |
First Address | Philadelphia, PA 19146-2036 |
Second Address | Philadelphia, PA 19118-3526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2019 |
Last Update Date | 18/09/2019 |