Healthcare Provider Details

I. General information

NPI: 1336804749
Provider Name (Legal Business Name): REBECCA LYNN HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DELTA DR STE A
WESTBROOK ME
04092-4745
US

IV. Provider business mailing address

1 DELTA DR STE A
WESTBROOK ME
04092-4745
US

V. Phone/Fax

Practice location:
  • Phone: 207-856-7227
  • Fax:
Mailing address:
  • Phone: 207-856-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC4978
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: