Healthcare Provider Details

I. General information

NPI: 1093307639
Provider Name (Legal Business Name): CHARLENE DANIELE HANSEN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 OLD CONEJO RD STE 202
NEWBURY PARK CA
91320-2153
US

IV. Provider business mailing address

3255 OLD CONEJO RD STE 202
NEWBURY PARK CA
91320-2153
US

V. Phone/Fax

Practice location:
  • Phone: 805-254-6249
  • Fax: 855-568-2494
Mailing address:
  • Phone: 805-254-6249
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-57046
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: