Provider Demographics
NPI:1134391337
Name:HANNA, KIMBERLY E (LICSW; LADC-1)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:E
Last Name:HANNA
Suffix:
Gender:F
Credentials:LICSW; LADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CAPE DR
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3046
Mailing Address - Country:US
Mailing Address - Phone:617-347-5298
Mailing Address - Fax:
Practice Address - Street 1:11 CAPE DR
Practice Address - Street 2:SUITE 13
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3046
Practice Address - Country:US
Practice Address - Phone:617-347-5298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189101YA0400X
MA1144011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)