Provider Demographics
NPI:1407399959
Name:HASAN, HADEEL SUFIAN (LCSW, CSAC)
Entity Type:Individual
Prefix:MS
First Name:HADEEL
Middle Name:SUFIAN
Last Name:HASAN
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2987 YARMOUTH GREENWAY DR STE 207
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5852
Mailing Address - Country:US
Mailing Address - Phone:608-286-1556
Mailing Address - Fax:
Practice Address - Street 1:2987 YARMOUTH GREENWAY DR STE 207
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5852
Practice Address - Country:US
Practice Address - Phone:608-286-1556
Practice Address - Fax:608-218-3796
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130451-121101YM0800X
WI9568123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health