Provider Demographics
NPI:1063241685
Name:HATCH, TRAESON
Entity type:Individual
Prefix:
First Name:TRAESON
Middle Name:
Last Name:HATCH
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LANGDON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3896
Mailing Address - Country:US
Mailing Address - Phone:435-262-0133
Mailing Address - Fax:
Practice Address - Street 1:107 AUDUBON RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1266
Practice Address - Country:US
Practice Address - Phone:435-262-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician