Provider Demographics
NPI:1104325265
Name:HANAN, MARGO (LCSW)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:
Last Name:HANAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5241
Mailing Address - Country:US
Mailing Address - Phone:718-382-0045
Mailing Address - Fax:718-382-0051
Practice Address - Street 1:1268 E 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5241
Practice Address - Country:US
Practice Address - Phone:718-382-0045
Practice Address - Fax:718-382-0051
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084550-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1041CO7OOXMedicaid