Provider Demographics
NPI:1447576012
Name:HASAN, WILLIAM (MA, LSW, LICDC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:HASAN
Suffix:
Gender:M
Credentials:MA, LSW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26777 LORAIN RD STE 320
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3225
Mailing Address - Country:US
Mailing Address - Phone:440-779-9565
Mailing Address - Fax:440-779-0437
Practice Address - Street 1:26777 LORAIN RD STE 320
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3225
Practice Address - Country:US
Practice Address - Phone:440-779-9565
Practice Address - Fax:440-779-0437
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH081251101YA0400X
OHS0018819104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)