Provider Demographics
NPI:1093307639
Name:HANSEN, CHARLENE DANIELE (MA)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:DANIELE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 OLD CONEJO RD STE 202
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2153
Mailing Address - Country:US
Mailing Address - Phone:805-254-6249
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:3255 OLD CONEJO RD STE 202
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2153
Practice Address - Country:US
Practice Address - Phone:805-254-6249
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA1-21-57046103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician