Basic Information
| Provider Information | |||||||||
| NPI: | 1821525155 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATLELID | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | MASON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 MANSFIELD ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021433102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173194069 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14 FORDHAM RD | ||||||||
| Address2: | |||||||||
| City: | ALLSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021343006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177826460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2017 | ||||||||
| LastUpdateDate: | 05/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.