Provider Demographics
NPI:1629407317
Name:HANSER, GRETCHEN A (OTR, PHD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:A
Last Name:HANSER
Suffix:
Gender:F
Credentials:OTR, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W 110TH ST
Mailing Address - Street 2:APT. 9A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2079
Mailing Address - Country:US
Mailing Address - Phone:919-923-8211
Mailing Address - Fax:
Practice Address - Street 1:510 W 110TH ST
Practice Address - Street 2:APT. 9A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2079
Practice Address - Country:US
Practice Address - Phone:919-923-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017796-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist