Provider Demographics
NPI:1245395482
Name:HACKEN, TANA (LCSW)
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:
Last Name:HACKEN
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 1:7 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8209
Mailing Address - Country:US
Mailing Address - Phone:973-633-1728
Mailing Address - Fax:973-633-9143
Practice Address - Street 1:7 WHEELER RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8209
Practice Address - Country:US
Practice Address - Phone:973-633-1728
Practice Address - Fax:973-633-9143
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003688001041C0700X
NYR031796-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q107651OtherCAQH
644132Medicare ID - Type Unspecified