Mark Sullivan Hanson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6390 Issued in MA

Practice address

130 Centre St
Wadsworth Village, Hathorne House #4
Danvers, MA 01923-1400

Phone

(978) 777-1088

Fax

(978) 777-3883

NPI assigned

Dec 2, 2006

Last updated

May 24, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hanson Psychological Services LLCGroup PAC ID 7719281492, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hanson Psychological Services LLC

  • Clinical Psychologist
  • Danvers, MA
  • NPI 1528382850
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1003984386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 CENTRE ST",
            "address_2": "SCHOOL HOUSE 101A",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019231400",
            "telephone_number": "978-777-1088",
            "fax_number": "978-777-3883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 CENTRE ST",
            "address_2": "WADSWORTH VILLAGE, HATHORNE HOUSE #4",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019231400",
            "telephone_number": "978-777-1088",
            "fax_number": "978-777-3883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSON",
        "first_name": "MARK",
        "middle_name": "SULLIVAN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-02",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "6390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "W06514",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shin Han, PHARM.D.
• Jacqueline Lee Hannigan, LICSW
• Samantha Leigh Hano
• Hanson Psychological Services LLC
• Dayna Hanson
• Harborside Massachusetts Limited Partnership (Twin Oaks Care and Rehabilitation Center)
• Harborside Massachusetts Limited Partnership (Hathorne Hill Center)
• Ashley Hardenstine
• Carrie V Harkin-David
• Katherine E Harkins, O.D.

• Clinical Psychologist in Danvers, MA
• Providers in Danvers, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.