Healthcare Provider Details

I. General information

NPI: 1285650887
Provider Name (Legal Business Name): MARTA BRIT HANSEN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 STATE HWY RTE 6
WELLFLEET MA
02667-7402
US

IV. Provider business mailing address

3073 STATE HWY RTE 6
WELLFLEET MA
02667-7406
US

V. Phone/Fax

Practice location:
  • Phone: 508-349-3131
  • Fax:
Mailing address:
  • Phone: 508-905-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114805
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801015316
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: