Provider Demographics
NPI:1447235866
Name:HANLEY, IAN (MSW LCSW)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:
Last Name:HANLEY
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E GREENTREE RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9418
Mailing Address - Country:US
Mailing Address - Phone:856-985-1667
Mailing Address - Fax:856-985-1490
Practice Address - Street 1:300 E GREENTREE RD
Practice Address - Street 2:SUITE 214
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9418
Practice Address - Country:US
Practice Address - Phone:856-985-1667
Practice Address - Fax:856-985-1490
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ445C014353001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
023231Medicare ID - Type Unspecified