Provider Demographics
NPI:1982731485
Name:HANSEN, DIANE G (EDD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:G
Last Name:HANSEN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CHANCERY CT
Mailing Address - Street 2:PH9
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-4248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 CHANCERY CT
Practice Address - Street 2:PH9
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4248
Practice Address - Country:US
Practice Address - Phone:617-373-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2979103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling