Provider Demographics
NPI:1275104325
Name:HANSEN, THOMAS L
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-1925
Mailing Address - Country:US
Mailing Address - Phone:732-690-0972
Mailing Address - Fax:
Practice Address - Street 1:85 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2437
Practice Address - Country:US
Practice Address - Phone:973-264-0023
Practice Address - Fax:973-264-0022
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004923001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical