Provider Demographics
NPI:1538620505
Name:HANNA, MARSHA E
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:E
Last Name:HANNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:E
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5288 BELLA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-5666
Mailing Address - Country:US
Mailing Address - Phone:619-504-6681
Mailing Address - Fax:
Practice Address - Street 1:5288 BELLA VISTA ST
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5666
Practice Address - Country:US
Practice Address - Phone:619-504-6681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA193031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical