Provider Demographics
NPI:1881238715
Name:HANSING, GRETTA DAHL (LMSW)
Entity type:Individual
Prefix:
First Name:GRETTA
Middle Name:DAHL
Last Name:HANSING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 S LAKE AVE APT 709
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-1124
Mailing Address - Country:US
Mailing Address - Phone:518-360-6279
Mailing Address - Fax:
Practice Address - Street 1:1641 3RD ST FL 2
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-1539
Practice Address - Country:US
Practice Address - Phone:518-463-8869
Practice Address - Fax:518-463-8733
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107598-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker