Healthcare Provider Details

I. General information

NPI: 1588013080
Provider Name (Legal Business Name): KATRINA HANNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 DON CT
STATEN ISLAND NY
10312-1574
US

IV. Provider business mailing address

134 N 4TH ST
BROOKLYN NY
11249-3296
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-3232
  • Fax:
Mailing address:
  • Phone: 646-450-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: