Provider Demographics
NPI:1750122487
Name:HANNA, COLIN ALEXANDER (LSW)
Entity type:Individual
Prefix:MR
First Name:COLIN
Middle Name:ALEXANDER
Last Name:HANNA
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 WALLINGFORD RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3965
Mailing Address - Country:US
Mailing Address - Phone:610-220-0427
Mailing Address - Fax:
Practice Address - Street 1:115 BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-4030
Practice Address - Country:US
Practice Address - Phone:484-887-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134187104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker