Provider Demographics
NPI:1043461098
Name:HANHAM, LEE-ANN
Entity Type:Individual
Prefix:MISS
First Name:LEE-ANN
Middle Name:
Last Name:HANHAM
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 1:3960 54TH ST
Mailing Address - Street 2:APT. 6P
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4237
Mailing Address - Country:US
Mailing Address - Phone:646-515-3159
Mailing Address - Fax:
Practice Address - Street 1:6120 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3557
Practice Address - Country:US
Practice Address - Phone:718-779-1234
Practice Address - Fax:718-779-7775
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072124-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical