Provider Demographics
NPI:1457173205
Name:BORNSTEIN, HANNAH ROSE (LAC)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ROSE
Last Name:BORNSTEIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:ROSE
Other - Last Name:BORNSTEIN-CHATANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1125 SHACKAMAXON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-4134
Mailing Address - Country:US
Mailing Address - Phone:831-588-3793
Mailing Address - Fax:
Practice Address - Street 1:1125 SHACKAMAXON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-4134
Practice Address - Country:US
Practice Address - Phone:831-588-3793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00825500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty