Provider Demographics
NPI:1487693388
Name:BLUESTONE, HANYA HARRIS (PHD)
Entity type:Individual
Prefix:DR
First Name:HANYA
Middle Name:HARRIS
Last Name:BLUESTONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:HANYA
Other - Middle Name:
Other - Last Name:BLUESTONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:8 BLACKTHORN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609
Mailing Address - Country:US
Mailing Address - Phone:774-239-0088
Mailing Address - Fax:508-799-9379
Practice Address - Street 1:185 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-1755
Practice Address - Country:US
Practice Address - Phone:774-239-0088
Practice Address - Fax:508-799-9379
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7130103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06136OtherBLUE SHIELD
MA461327OtherTUFTS
MA2098796OtherCIGNA
MA2098796OtherCIGNA