MEDICARE: DR. CHARLES E HANSON PH.D.

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	103TC0700X	Clinical Psychologist	PSY8639	CA

General Provider Information

NPI Number	:	1851443295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES E HANSON PH.D.

Provider Business Mailing Address
First Line	:	9003 RESEDA BLVD
Second Line	:	208
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-3920
Country	:	US
Telephone Number	:	818-772-0177
Fax Number	:	310-455-4023

Provider Business Practice Location Address
First Line	:	9003 RESEDA BLVD
Second Line	:	208
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-3920
Country	:	US
Telephone Number	:	818-772-0177
Fax Number	:	310-455-4023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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