| Doctor Name: | DR. MARK SULLIVAN HANSON |
| NPI Number: | 1003984386 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 6390 |
| Business Practice Address: | 130 Centre St Wadsworth Village, Hathorne House #4 Danvers, MA - 019231400 |
| Business Phone Number: | 9787771088 |
| Business Fax Number: | 9787773883 |
| Mailing Address: | 130 Centre St, Wadsworth Village, Hathorne House #4 DANVERS |
| State: | MA |
| Postal Code: | 019231400 |
| Phone Number: | 9787771088 |
| Fax Number: | 9787773883 |
| NPI Enumeration Date: | 12/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6390 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |