Provider Demographics
NPI:1346396868
Name:HANSEN, MARIEL N (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:MARIEL
Middle Name:N
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 HENRY HUDSON PKWY
Mailing Address - Street 2:STE 3IS
Mailing Address - City:RIVERDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-549-3098
Mailing Address - Fax:
Practice Address - Street 1:3616 HENRY HUDSON PKWY
Practice Address - Street 2:STE 3IS
Practice Address - City:RIVERDALE
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-549-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0153621104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker