Individual
DR. MARK SULLIVAN HANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
130 CENTRE ST, WADSWORTH VILLAGE, HATHORNE HOUSE #4, DANVERS, MA 01923-1400
(978) 777-1088
(978) 777-3883
Mailing address
130 CENTRE ST, SCHOOL HOUSE 101A, DANVERS, MA 01923-1400
(978) 777-1088
(978) 777-3883
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6390
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W06514
BLUE CROSS BLUE SHIELD
MA
Enumeration date
12/02/2006
Last updated
05/24/2021
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