Provider Demographics
NPI:1174112676
Name:HATTER, NERISSA KADEY (NCC)
Entity type:Individual
Prefix:
First Name:NERISSA
Middle Name:KADEY
Last Name:HATTER
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 E PALMER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3320
Mailing Address - Country:US
Mailing Address - Phone:209-543-5300
Mailing Address - Fax:
Practice Address - Street 1:4617 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3836
Practice Address - Country:US
Practice Address - Phone:267-636-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health