Active NPI
Karen Hetzel, PHD, APRN, BC
- Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
- Brockton, MA
National Provider Identifier
1013054998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
- License
- 144649
- Practice address
- 1342 Belmont St
Suite 101
Brockton, MA 02301-4437 - Phone
- (508) 583-1600
- NPI assigned
- Jan 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist | 364SP0807X | 144649 | MA | Primary |
Addresses
Primary practice location
1342 Belmont St
Suite 101
Brockton, MA 02301-4437
Mailing address
1342 Belmont St
Suite 101
Brockton, MA 02301-4436
Phone (508) 238-6956
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005176 | Other | MA | VALUE OPTIONS |
| 790700 | Other | MA | TUFTS |
| PN0031 | Other | MA | BCBS |
| 1028770 | Other | MA | FALLON-BEACON HEALTH STRA |
| 306175 | Other | MA | MAGELLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Specialist, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 144649 | MA | MD | Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013054998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1342 BELMONT ST",
"address_2": "SUITE 101",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023014436",
"telephone_number": "508-238-6956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1342 BELMONT ST",
"address_2": "SUITE 101",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023014437",
"telephone_number": "508-583-1600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HETZEL",
"first_name": "KAREN",
"name_prefix": "Dr.",
"credential": "PHD, APRN, BC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "364SP0807X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Adolescent",
"state": "MA",
"license": "144649",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "005176",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "790700",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "PN0031",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON-BEACON HEALTH STRA",
"identifier": "1028770",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "306175",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.