Provider Demographics
NPI:1699127852
Name:HACKETT, BRYNA D
Entity type:Individual
Prefix:
First Name:BRYNA
Middle Name:D
Last Name:HACKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WALNUT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4054
Mailing Address - Country:US
Mailing Address - Phone:888-897-1887
Mailing Address - Fax:703-321-2603
Practice Address - Street 1:101 WALNUT ST STE 200
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4054
Practice Address - Country:US
Practice Address - Phone:888-897-1887
Practice Address - Fax:703-321-2603
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA090400094891041C0700X
MALICSW1226611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical