Active NPI
Mary Roberta Hansen, B.S.
- Social Worker
- Green Bay, WI
National Provider Identifier
1346610532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 1684-120
- Practice address
- 111 N Jefferson St
Green Bay, WI 54301-5005 - Phone
- (920) 448-6328
- Fax
- (920) 448-6065
- NPI assigned
- Sep 30, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 1684-120 | WI | Primary |
Addresses
Primary practice location
111 N Jefferson St
Green Bay, WI 54301-5005
Mailing address
2540 Garden Park Ter
Green Bay, WI 54311-6744
Phone (920) 448-6328
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1684-120 | WI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443571200000",
"number": "1346610532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2540 GARDEN PARK TER",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543116744",
"telephone_number": "920-448-6328",
"fax_number": "920-448-6065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 N JEFFERSON ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543015005",
"telephone_number": "920-448-6328",
"fax_number": "920-448-6065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "MARY",
"middle_name": "ROBERTA",
"name_prefix": "Ms.",
"credential": "B.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-30",
"last_updated": "2015-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WI",
"license": "1684-120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.