Provider Demographics
NPI:1336736396
Name:HANNON, PAULA (LCSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:HANNON
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 1:3801 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-7395
Mailing Address - Country:US
Mailing Address - Phone:941-769-1035
Mailing Address - Fax:
Practice Address - Street 1:3801 MAGNOLIA WAY
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-7395
Practice Address - Country:US
Practice Address - Phone:941-769-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-24
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW128691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical