Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 116468 | MA |
Y | 1041C0700X | Clinical Social Worker | 23641 | CA |
NPI | 1003012626 |
---|---|
Provider Name | Julie Ann Hansen |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 17/01/2014 |