Provider Demographics
NPI:1275816837
Name:HANNAGAN, ANN L (LMSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:HANNAGAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 WILMA ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4516
Mailing Address - Country:US
Mailing Address - Phone:607-786-0605
Mailing Address - Fax:
Practice Address - Street 1:608 WILMA ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4516
Practice Address - Country:US
Practice Address - Phone:607-786-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083566-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool