Provider Demographics
NPI:1528190717
Name:HANSEN, RUTH A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:A
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:RUTH
Other - Middle Name:A
Other - Last Name:AGUILAR-HANSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8461 E HILLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-2427
Mailing Address - Country:US
Mailing Address - Phone:520-909-0017
Mailing Address - Fax:
Practice Address - Street 1:1010 E 10TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5813
Practice Address - Country:US
Practice Address - Phone:520-909-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 102261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ588329Medicaid