Provider Demographics
NPI:1851443295
Name:HANSON, CHARLES E (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:HANSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9003 RESEDA BLVD
Mailing Address - Street 2:208
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3920
Mailing Address - Country:US
Mailing Address - Phone:818-772-0177
Mailing Address - Fax:310-455-4023
Practice Address - Street 1:9003 RESEDA BLVD
Practice Address - Street 2:208
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3920
Practice Address - Country:US
Practice Address - Phone:818-772-0177
Practice Address - Fax:310-455-4023
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8639103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8639Medicare ID - Type UnspecifiedPSYCHOLOGIST