Provider Demographics
NPI:1285650887
Name:HANSEN, MARTA BRIT (LICSW)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:BRIT
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3073 STATE HWY RTE 6
Mailing Address - Street 2:
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667-7406
Mailing Address - Country:US
Mailing Address - Phone:508-905-2800
Mailing Address - Fax:
Practice Address - Street 1:3130 STATE HWY RTE 6
Practice Address - Street 2:
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667-7402
Practice Address - Country:US
Practice Address - Phone:508-349-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1148051041C0700X
MI68010153161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC36108016Medicare ID - Type Unspecified