Provider Demographics
NPI:1316080575
Name:HAWKS, BRENDA K (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:K
Last Name:HAWKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:194 ORCHARD ST
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478
Mailing Address - Country:US
Mailing Address - Phone:617-484-5804
Mailing Address - Fax:781-891-2474
Practice Address - Street 1:175 FOREST ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452
Practice Address - Country:US
Practice Address - Phone:781-891-2265
Practice Address - Fax:781-891-2474
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4916103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist