Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY27482 | CA |
N | 103T00000X | Psychologist | PSY27482 | CA |
N | 103G00000X | Clinical Psychologist | PSY27482 | CA |
N | 103TC0700X | Clinical Psychologist | PSY27482 | CA |
Y | 102L00000X | Psychologist | PSY27482 | CA |
Y | 103T00000X | Psychologist | PSY27482 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY27482 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY27482 | CA |
N | 103G00000X | Clinical Psychologist | PSB31213 | CA |
N | 103TC0700X | Clinical Psychologist | PSB31213 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY27482 | CA |
NPI | 1184792293 |
---|---|
Provider Name | Dr. Alicia Susana Hansen |
First Address | Glendale, CA 91206-2266 |
Second Address | Glendale, CA 91206-2266 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 28/08/2015 |