Provider Demographics
NPI:1124282470
Name:HANLEY, KATHERINE SANDRA (PMHNP-BC, LMHC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SANDRA
Last Name:HANLEY
Suffix:
Gender:F
Credentials:PMHNP-BC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-7122
Mailing Address - Country:US
Mailing Address - Phone:857-225-4076
Mailing Address - Fax:508-408-6199
Practice Address - Street 1:30 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-7122
Practice Address - Country:US
Practice Address - Phone:857-225-4076
Practice Address - Fax:508-408-6199
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2290510363LP0808X, 163W00000X
MA8236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse