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NPI Code Detail

MEDICARE: HANSEN BEHAVIORAL HEALTH A PSYCHOLOGICAL CORPORATION

MEDICARE: HANSEN BEHAVIORAL HEALTH A PSYCHOLOGICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY27482CA

General Provider Information

NPI Number : 1366809790
Entity Type Code : Organization
Provider Name (Legal Business Name) : HANSEN BEHAVIORAL HEALTH A PSYCHOLOGICAL CORPORATION
Provider Business Mailing Address
First Line : 524 N MARYLAND AVE
Second Line : SUITE 1
City : GLENDALE
State : CA
Zip : 91206-2266
Country : US
Telephone Number : 213-448-2835
Fax Number : 213-405-2413
Provider Business Practice Location Address
First Line : 524 N MARYLAND AVE
Second Line : SUITE 1
City : GLENDALE
State : CA
Zip : 91206-2266
Country : US
Telephone Number : 213-448-2835
Fax Number : 213-405-2413
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : DR. ALICIA SUSANA HANSEN
Credential : P.H.D.
Telephone Number : 213-448-2835
Provider Enumeration Date : 01/15/2016
Last Update Date : 01/15/2016

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