Provider Demographics
NPI:1801250402
Name:HANSEN, ALYSSA GRACE (LCSW, IBCLC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:GRACE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LCSW, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 E CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3107
Mailing Address - Country:US
Mailing Address - Phone:267-417-9525
Mailing Address - Fax:
Practice Address - Street 1:3641 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2603
Practice Address - Country:US
Practice Address - Phone:267-417-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-09
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-316831174N00000X
PACW0192471041C0700X
PASW130660104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No104100000XBehavioral Health & Social Service ProvidersSocial Worker