Provider Demographics
NPI:1679773592
Name:SMITH-HANSEN, LOTTE (PHD)
Entity type:Individual
Prefix:
First Name:LOTTE
Middle Name:
Last Name:SMITH-HANSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HANCOCK ST
Mailing Address - Street 2:# 107
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3188
Mailing Address - Country:US
Mailing Address - Phone:617-299-9789
Mailing Address - Fax:
Practice Address - Street 1:49 HANCOCK ST
Practice Address - Street 2:# 107
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3188
Practice Address - Country:US
Practice Address - Phone:617-299-9789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical