Provider Demographics
NPI:1699968545
Name:HANSEN, MEREDITH LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:LYNN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4667 MACARTHUR BLVD
Mailing Address - Street 2:320
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1817
Mailing Address - Country:US
Mailing Address - Phone:949-375-9220
Mailing Address - Fax:
Practice Address - Street 1:4667 MACARTHUR BLVD
Practice Address - Street 2:320
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1817
Practice Address - Country:US
Practice Address - Phone:949-375-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22674103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical