Healthcare Provider Details

I. General information

NPI: 1942416086
Provider Name (Legal Business Name): MARLENE S HANLON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 LOTUS ST
IRVINE CA
92606-2118
US

IV. Provider business mailing address

3511 LOTUS ST
IRVINE CA
92606-2118
US

V. Phone/Fax

Practice location:
  • Phone: 949-857-8223
  • Fax:
Mailing address:
  • Phone: 949-857-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY8219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: