Provider Demographics
NPI:1114144714
Name:HANSEN, GAYNA PATRICIA (MA)
Entity Type:Individual
Prefix:MRS
First Name:GAYNA
Middle Name:PATRICIA
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 1:1202 WINDING MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-8408
Mailing Address - Country:US
Mailing Address - Phone:321-433-2491
Mailing Address - Fax:
Practice Address - Street 1:96 WILLARD ST
Practice Address - Street 2:1127 S.PATRICK DR; SATELLITE BEACH, FL 32937
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7991
Practice Address - Country:US
Practice Address - Phone:321-638-0027
Practice Address - Fax:321-638-0115
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health