Perry Hazeltine, PH.D.

Key facts

NPI

1861409583

Entity type

Individual (NPI type 1)

Primary specialty

Counseling Psychologist 103TC1900X

License

PS007197L (PA)

Practice address

243 N Duke St
Ste 1
Lancaster, PA 17602-2779

Phone

(717) 875-8993

NPI assigned

Aug 2, 2006

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Philosophy

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 14, 2016.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465862400000",
    "number": "1861409583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 N DUKE ST",
            "address_2": "STE 1",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176022779",
            "telephone_number": "717-875-8993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 N DUKE ST",
            "address_2": "STE 1",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176022779",
            "telephone_number": "717-875-8993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZELTINE",
        "first_name": "PERRY",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2016-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "PA",
            "license": "PS007197L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITALBLUECROSS",
            "identifier": "02153901",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUEOPTIONS",
            "identifier": "214037",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "842925",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLIANCE",
            "identifier": "250533",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMEDICARE",
            "identifier": "620005401",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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