Provider Demographics
NPI:1174062244
Name:HARDY, MARYELLEN REGINA
Entity type:Individual
Prefix:MRS
First Name:MARYELLEN
Middle Name:REGINA
Last Name:HARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MILLER LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2217
Mailing Address - Country:US
Mailing Address - Phone:908-253-6399
Mailing Address - Fax:
Practice Address - Street 1:126 MILLER LN
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2217
Practice Address - Country:US
Practice Address - Phone:908-253-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician