Provider Demographics
NPI:1548040561
Name:HATTEBERG, HADLEY (LPC)
Entity type:Individual
Prefix:
First Name:HADLEY
Middle Name:
Last Name:HATTEBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 NEPSA WAY APT 4102
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1721
Mailing Address - Country:US
Mailing Address - Phone:216-973-7496
Mailing Address - Fax:
Practice Address - Street 1:1000 W MCNAB RD STE 259
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4719
Practice Address - Country:US
Practice Address - Phone:954-271-4705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health