Provider Demographics
NPI:1477621753
Name:HANSON, JEAN SULLIVAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:SULLIVAN
Last Name:HANSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CENTRE ST
Mailing Address - Street 2:SCHOOL HOUSE 101A
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1400
Mailing Address - Country:US
Mailing Address - Phone:978-777-0810
Mailing Address - Fax:978-777-0889
Practice Address - Street 1:130 CENTRE ST
Practice Address - Street 2:WADSWORTH VILLAGE, HATHORNE HOUSE, #2
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1400
Practice Address - Country:US
Practice Address - Phone:978-777-0810
Practice Address - Fax:978-777-0889
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6389103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06383OtherBLUE CROSS BLUE SHIELD
MA779620-000OtherPACIFICARE
MAW06383OtherBLUE CROSS BLUE SHIELD
MAHA W51381Medicare ID - Type Unspecified