Provider Demographics
NPI:1710075148
Name:HANSBURG, FREDA B (PHD)
Entity Type:Individual
Prefix:
First Name:FREDA
Middle Name:B
Last Name:HANSBURG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 SUMMIT AVENUE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3613
Mailing Address - Country:US
Mailing Address - Phone:908-273-5558
Mailing Address - Fax:908-273-3355
Practice Address - Street 1:51 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3613
Practice Address - Country:US
Practice Address - Phone:908-273-5558
Practice Address - Fax:908-273-3355
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3046103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist