Provider Demographics
NPI:1114639952
Name:HANSEN, TREVOR ARTHUR (MSW)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:ARTHUR
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6219 WOODHAVEN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6850
Mailing Address - Country:US
Mailing Address - Phone:954-512-9873
Mailing Address - Fax:
Practice Address - Street 1:6219 WOODHAVEN VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6850
Practice Address - Country:US
Practice Address - Phone:954-512-9873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker