Provider Demographics
NPI:1366684631
Name:DEBORAH D. HANNA LCSW PA
Entity Type:Organization
Organization Name:DEBORAH D. HANNA LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-273-6747
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32004-0721
Mailing Address - Country:US
Mailing Address - Phone:904-273-6747
Mailing Address - Fax:904-273-6861
Practice Address - Street 1:100 EXECUTIVE WAY
Practice Address - Street 2:SUITE 113
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-2715
Practice Address - Country:US
Practice Address - Phone:904-273-6747
Practice Address - Fax:904-273-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR60215Medicare UPIN