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NPI Code Detail

MEDICARE: ALYSSA GRACE HANSEN LCSW, IBCLC

MEDICARE: ALYSSA GRACE HANSEN LCSW, IBCLC
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
1174N00000XLactation Consultant (Non-RN)L-316831
21041C0700XClinical Social WorkerCW019247PA
3104100000XSocial WorkerSW130660PA

General Provider Information

NPI Number : 1801250402
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA GRACE HANSEN LCSW, IBCLC
Provider Business Mailing Address
First Line : 2512 E CUMBERLAND ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19125-3107
Country : US
Telephone Number : 267-417-9525
Fax Number :
Provider Business Practice Location Address
First Line : 3641 LANCASTER AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-2603
Country : US
Telephone Number : 267-417-9525
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2016
Last Update Date : 01/20/2025

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