Provider Demographics
NPI:1851592190
Name:HACKWORTH, HANNAH (LCSW)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:HACKWORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:FOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4300 SW 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4006
Mailing Address - Country:US
Mailing Address - Phone:352-374-5600
Mailing Address - Fax:904-807-1220
Practice Address - Street 1:4250 LAKESIDE DR
Practice Address - Street 2:STE. 116
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3358
Practice Address - Country:US
Practice Address - Phone:904-807-1230
Practice Address - Fax:904-807-1220
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 78641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical