Provider Demographics
NPI:1205133865
Name:HANSEN, CHRISTINE M (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:M
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 AQUA MARINE BLVD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2651
Mailing Address - Country:US
Mailing Address - Phone:216-287-5759
Mailing Address - Fax:216-378-3906
Practice Address - Street 1:3001 AQUA MARINE BLVD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-2651
Practice Address - Country:US
Practice Address - Phone:216-287-5759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.00251251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid