Provider Demographics
NPI:1689898363
Name:HANSON, LARA BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LARA
Middle Name:BETH
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 N BRAND BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3012
Mailing Address - Country:US
Mailing Address - Phone:818-945-0570
Mailing Address - Fax:
Practice Address - Street 1:1139 NORTH BRAND BLVD. STE. A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202
Practice Address - Country:US
Practice Address - Phone:818-945-0570
Practice Address - Fax:818-487-6999
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23532104100000X, 1041C0700X
CALCS235321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker