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General NPI Number Information
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NPI Number | 1801250402
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Entity Type | Individual
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Provider Name | ALYSSA GRACE HANSEN LCSW, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 04/09/2016
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 3641 LANCASTER AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2603
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Country | US
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Telephone | 267-417-9525
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Fax |
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Provider Business Mailing Address
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Address Line | 2512 E CUMBERLAND ST
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3107
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Country | US
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Telephone | 267-417-9525
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-316831
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW019247
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW130660
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License Number State | PA
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