Provider Demographics
NPI:1972892834
Name:HATZIS, JAMIE R (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:R
Last Name:HATZIS
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 TRUDY DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2634
Mailing Address - Country:US
Mailing Address - Phone:917-848-1188
Mailing Address - Fax:
Practice Address - Street 1:12 TRUDY DR
Practice Address - Street 2:
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916-2634
Practice Address - Country:US
Practice Address - Phone:191-784-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083026104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker