Healthcare Provider Details

I. General information

NPI: 1184792293
Provider Name (Legal Business Name): ALICIA SUSANA HANSEN PH.D PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA SUSANA HANSEN DOCTOR IN PSYCHOLOGY

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N MARYLAND AVE APT 1
GLENDALE CA
91206-2266
US

IV. Provider business mailing address

524 N MARYLAND AVE APT 1
GLENDALE CA
91206-2266
US

V. Phone/Fax

Practice location:
  • Phone: 213-448-2835
  • Fax:
Mailing address:
  • Phone: 213-448-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB31213
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPSY27482
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY27482
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY27482
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY27482
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY27482
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY27482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: