Provider Demographics
NPI:1972641942
Name:HAZY, GARY RUSSELL (MS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:RUSSELL
Last Name:HAZY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 S 14TH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2535
Mailing Address - Country:US
Mailing Address - Phone:724-422-0395
Mailing Address - Fax:
Practice Address - Street 1:1101 HARTMAN ST
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-1500
Practice Address - Country:US
Practice Address - Phone:412-673-5800
Practice Address - Fax:412-673-5805
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health