Provider Demographics
NPI:1730237389
Name:HANSEN, RAYMOND ALAN (MA, LPC, LADC, CEAP)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:ALAN
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MA, LPC, LADC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-0261
Mailing Address - Country:US
Mailing Address - Phone:860-916-1170
Mailing Address - Fax:860-843-4939
Practice Address - Street 1:195 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3685
Practice Address - Country:US
Practice Address - Phone:860-916-1170
Practice Address - Fax:860-843-4939
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001238101Y00000X
CT000685101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)