Provider Demographics
NPI:1851463012
Name:HANUSA, DARALD R (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARALD
Middle Name:R
Last Name:HANUSA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2872 DUNTON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711
Mailing Address - Country:US
Mailing Address - Phone:608-274-0618
Mailing Address - Fax:608-274-5323
Practice Address - Street 1:313 PRICE PLACE
Practice Address - Street 2:SUITE 10
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3250
Practice Address - Country:US
Practice Address - Phone:608-231-3300
Practice Address - Fax:608-231-0644
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12720101YA0400X
WI18061231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical