Provider Demographics
NPI:1073885158
Name:HANSEN, ANDREA E
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:E
Last Name:HANSEN
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 1:17 EAST GENESEE STREET
Mailing Address - Street 2:CAYUGA COUNSELING SERVICES
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021
Mailing Address - Country:US
Mailing Address - Phone:315-253-9795
Mailing Address - Fax:315-253-3255
Practice Address - Street 1:17 EAST GENESEE STREET
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021
Practice Address - Country:US
Practice Address - Phone:315-253-9795
Practice Address - Fax:315-253-3255
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY160978035Medicaid