Provider Demographics
NPI:1902393028
Name:MANSFIELD, HANNAH ALEXANDRA
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ALEXANDRA
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 LOMA DE ORO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3710
Mailing Address - Country:US
Mailing Address - Phone:909-809-9955
Mailing Address - Fax:
Practice Address - Street 1:140 W FRANKLIN ST STE 202
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2725
Practice Address - Country:US
Practice Address - Phone:800-991-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician