Provider Demographics
NPI:1497974406
Name:HANOVER, NED G (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NED
Middle Name:G
Last Name:HANOVER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-0261
Mailing Address - Country:US
Mailing Address - Phone:856-291-6400
Mailing Address - Fax:856-291-7202
Practice Address - Street 1:1203 SEDGEFIELD DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1857
Practice Address - Country:US
Practice Address - Phone:856-291-6400
Practice Address - Fax:856-291-7202
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0158271041C0700X
DEQ1-00118521041C0700X
NJ44SC053451001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0511668Medicaid