Healthcare Provider Details

I. General information

NPI: 1760227615
Provider Name (Legal Business Name): JESSICA HANSMANN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 POST RD E STE 202
WESTPORT CT
06880-3616
US

IV. Provider business mailing address

75 CONCORD DR
MAHOPAC NY
10541-2027
US

V. Phone/Fax

Practice location:
  • Phone: 203-227-4555
  • Fax:
Mailing address:
  • Phone: 914-582-3754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123709
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17132
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1145095
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL07185800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: