Provider Demographics
NPI:1508649328
Name:HANNEL, TINA-LOUISE
Entity Type:Individual
Prefix:MS
First Name:TINA-LOUISE
Middle Name:
Last Name:HANNEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BROADHURST ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3107
Mailing Address - Country:US
Mailing Address - Phone:631-260-6787
Mailing Address - Fax:
Practice Address - Street 1:650 HALLOCK AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1256
Practice Address - Country:US
Practice Address - Phone:631-403-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health