Provider Demographics
NPI:1184792293
Name:HANSEN, ALICIA SUSANA (PHD PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:SUSANA
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGIST
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:SUSANA
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOCTOR IN PSYCHOLOGY
Mailing Address - Street 1:524 N MARYLAND AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2266
Mailing Address - Country:US
Mailing Address - Phone:213-448-2835
Mailing Address - Fax:
Practice Address - Street 1:524 N MARYLAND AVE APT 1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-2266
Practice Address - Country:US
Practice Address - Phone:213-448-2835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB31213103TC0700X
CAPSY27482102L00000X, 103TA0700X, 103TB0200X, 103G00000X, 103T00000X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation