Individual
MR. KEVIN JAY HANSEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
601 WEST GEORGE ST, CARMICHAELS, PA 15320-1325
(724) 966-5081
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288440093
—
PA
01
—
328834A764918
VALUE BEHAVIORAL HEALTH
PA
Enumeration date
08/06/2009
Last updated
08/06/2009
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