Provider Demographics
NPI:1689045387
Name:HANSELL, LYDIA (PSYD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:HANSELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LYDIA
Other - Last Name:HANSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-0083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 MALAGA COVE PLZ STE 3
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-1396
Practice Address - Country:US
Practice Address - Phone:213-787-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31649103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program