Provider Demographics
NPI:1760686208
Name:HANSEN, JOANN MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:MARIE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:MAREI
Other - Last Name:KOPEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:444 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3926
Mailing Address - Country:US
Mailing Address - Phone:860-646-3888
Mailing Address - Fax:860-645-4132
Practice Address - Street 1:444 CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-646-3888
Practice Address - Fax:860-645-4132
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0072291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical