Provider Demographics
NPI:1649834482
Name:HANSON, MATTHEW C
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:HANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WILLIS RD
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-5125
Mailing Address - Country:US
Mailing Address - Phone:508-527-5120
Mailing Address - Fax:
Practice Address - Street 1:35 CONGRESS ST STE 214
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-7312
Practice Address - Country:US
Practice Address - Phone:978-542-1951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAN0169835801OtherTUFTS HEALTH DIRECT