Provider Demographics
NPI:1699106617
Name:HACKETT, BRYAN
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:HACKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 8TH AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2268
Mailing Address - Country:US
Mailing Address - Phone:973-390-8230
Mailing Address - Fax:
Practice Address - Street 1:102 8TH AVE
Practice Address - Street 2:APT 2
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2268
Practice Address - Country:US
Practice Address - Phone:973-390-8230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-01
Last Update Date:2013-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00388000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional