Provider Demographics
NPI:1316283997
Name:HANSEN, ERICA LEIGH (LSW)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LEIGH
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3920
Mailing Address - Country:US
Mailing Address - Phone:908-370-5665
Mailing Address - Fax:
Practice Address - Street 1:1945 HWY 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-776-2325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-30
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05726900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223471515Medicaid