Provider Demographics
NPI:1104155217
Name:HETTRICH, EMMA LEAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:EMMA LEAH
Middle Name:
Last Name:HETTRICH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4423
Mailing Address - Country:US
Mailing Address - Phone:631-338-7088
Mailing Address - Fax:
Practice Address - Street 1:400 SUNSET LN
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4423
Practice Address - Country:US
Practice Address - Phone:631-338-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool