Provider Demographics
NPI:1396806345
Name:HANSEN, THOMAS DUANE (LCSW)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DUANE
Last Name:HANSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1582
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1582
Mailing Address - Country:US
Mailing Address - Phone:207-664-0097
Mailing Address - Fax:207-664-0097
Practice Address - Street 1:210 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1949
Practice Address - Country:US
Practice Address - Phone:207-664-0097
Practice Address - Fax:207-664-0097
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME10791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME026657OtherBLUE CROSS BLUE SHIELD
MEMM5391Medicare PIN