=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376728543
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID M HANSEN PHD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2008
-----------------------------------------------------
Last Update Date | 01/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 FAIRMONT AVE
-----------------------------------------------------
City | POUGHKEEPSIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12603-2423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-485-1171
-----------------------------------------------------
Fax | 845-485-1171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37 FAIRMONT AVE
-----------------------------------------------------
City | POUGHKEEPSIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12603-2423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-485-1171
-----------------------------------------------------
Fax | 845-485-1171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID HANSEN HANSEN
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 845-485-1171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 008399-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------