Provider Demographics
NPI:1538633599
Name:HANSEN, DEBRA A (LCSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 COMMERCIAL ST STE 3004
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1118
Mailing Address - Country:US
Mailing Address - Phone:603-668-3050
Mailing Address - Fax:603-668-8666
Practice Address - Street 1:250 COMMERCIAL ST STE 3004
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1118
Practice Address - Country:US
Practice Address - Phone:603-668-3050
Practice Address - Fax:603-668-8666
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW131421041C0700X
NH21911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076408Medicaid