Provider Demographics
NPI:1235685181
Name:HANSEN, ANGELA MARIA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LCSW
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 DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128
Mailing Address - Country:US
Mailing Address - Phone:786-393-0315
Mailing Address - Fax:786-396-9605
Practice Address - Street 1:760 NW 107TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3155
Practice Address - Country:US
Practice Address - Phone:786-393-0315
Practice Address - Fax:786-396-9605
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103K00000X
FLSW185671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst