Provider Demographics
NPI:1265663884
Name:HAHN, GEORGE FRITZ (LISW)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:FRITZ
Last Name:HAHN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-0402
Mailing Address - Country:US
Mailing Address - Phone:575-758-9585
Mailing Address - Fax:
Practice Address - Street 1:1003 GUSDORF RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6615
Practice Address - Country:US
Practice Address - Phone:575-758-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM 068131041C0700X
NMI-074301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical