Provider Demographics
NPI:1023024148
Name:HANSEN, SUSAN RIGGS (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RIGGS
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 NORTH FRANKLIN STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-3536
Mailing Address - Country:US
Mailing Address - Phone:214-723-7005
Mailing Address - Fax:215-453-5181
Practice Address - Street 1:16 NORTH FRANKLIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-3536
Practice Address - Country:US
Practice Address - Phone:214-723-7005
Practice Address - Fax:215-453-5181
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0139491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA159262000OtherMAGELLAN BEHAVIORAL HEALT
PA01965054Medicaid