Provider Demographics
NPI:1982754438
Name:HANSON RICHARDSON, REBECCA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:HANSON RICHARDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BELMONT ST
Mailing Address - Street 2:6B WORCESTER STATE HOSPITAL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1681
Mailing Address - Country:US
Mailing Address - Phone:508-368-3458
Mailing Address - Fax:
Practice Address - Street 1:305 BELMONT ST
Practice Address - Street 2:6B WORCESTER STATE HOSPITAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1681
Practice Address - Country:US
Practice Address - Phone:508-368-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7836103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARI W50782Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER