Provider Demographics
NPI:1144280090
Name:HANSON, GREGORY DONALD (PHD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:DONALD
Last Name:HANSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 NEWFIELD ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1846
Mailing Address - Country:US
Mailing Address - Phone:860-523-0177
Mailing Address - Fax:860-523-4300
Practice Address - Street 1:769 NEWFIELD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1846
Practice Address - Country:US
Practice Address - Phone:860-523-0177
Practice Address - Fax:860-523-4300
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical