Provider Demographics
NPI:1861995656
Name:HATEN, NASTASSIA RENEE (CPT)
Entity type:Individual
Prefix:MRS
First Name:NASTASSIA
Middle Name:RENEE
Last Name:HATEN
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:MRS
Other - First Name:NASTASSIA
Other - Middle Name:RENEE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2896 KUMAKALII ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-7061
Mailing Address - Country:US
Mailing Address - Phone:504-292-1509
Mailing Address - Fax:504-292-1509
Practice Address - Street 1:1100 ALAKEA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2833
Practice Address - Country:US
Practice Address - Phone:808-523-7771
Practice Address - Fax:808-523-1997
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician