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NPI Code Detail

MEDICARE: MRS. PAMELA JO HANSEN L.C.S.W

MEDICARE: MRS. PAMELA JO HANSEN L.C.S.W
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
11041C0700XClinical Social WorkerLCS14770CA

General Provider Information

NPI Number : 1427189299
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PAMELA JO HANSEN L.C.S.W
Provider Business Mailing Address
First Line : PO BOX 17403
Second Line :
City : SAN DIEGO
State : CA
Zip : 92177-7403
Country : US
Telephone Number : 619-723-7716
Fax Number : 858-279-2763
Provider Business Practice Location Address
First Line : 3002 ARMSTRONG ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-5702
Country : US
Telephone Number : 858-277-9550
Fax Number : 858-279-2763
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 07/08/2007

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