MEDICARE: HANSEN-COHEN ASSOCIATES IN PSYCHOLOGY, INC

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
1	103T00000X	Psychologist	PY7935	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PY 7935	OTHER	FL	STATE OF FLORIDA DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1770877318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANSEN-COHEN ASSOCIATES IN PSYCHOLOGY, INC

Provider Business Mailing Address
First Line	:	4301 VERONICA S SHOEMAKER BLVD STE B
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-2216
Country	:	US
Telephone Number	:	239-274-7792
Fax Number	:	239-247-5344

Provider Business Practice Location Address
First Line	:	4301 VERONICA S SHOEMAKER BLVD STE B
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-2216
Country	:	US
Telephone Number	:	239-274-7792
Fax Number	:	239-247-5344

Authorized Official
Title or Position	:	PRESIDENT/LICENSED PSYCHOLOGIST
Name	:	DR. CHRISTINA MARIE HANSEN
Credential	:	PSY.D.
Telephone Number	:	239-274-7792

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	05/31/2011

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