Provider Demographics
NPI:1346664604
Name:FEDERICO HASSAN, MIGUELANGEL CARLOS JOSE (MPSY, LPC)
Entity Type:Individual
Prefix:MR
First Name:MIGUELANGEL
Middle Name:CARLOS JOSE
Last Name:FEDERICO HASSAN
Suffix:
Gender:M
Credentials:MPSY, LPC
Other - Prefix:
Other - First Name:MIGUEL
Other - Middle Name:C
Other - Last Name:FEDERICO HASSAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPSY, LPC
Mailing Address - Street 1:4880 E 29TH ST
Mailing Address - Street 2:#17203
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-6462
Mailing Address - Country:US
Mailing Address - Phone:520-820-7154
Mailing Address - Fax:
Practice Address - Street 1:4880 E 29TH ST
Practice Address - Street 2:#17203
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-444-7521
Practice Address - Fax:954-656-9317
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLPC46.003104101YM0800X, 101YP2500X, 103T00000X, 101YP2500X, 103T00000X
AZLPC-18498101YM0800X, 101YP2500X
AZLPC006216T101YP2500X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12766971OtherCAQH
AZLPC-18498OtherAZ BBHE
CTLPC-3104OtherCT DPH
CT008071926Medicaid