Provider Demographics
NPI:1043616204
Name:HANNA, COLEEN ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:COLEEN
Middle Name:ANN
Last Name:HANNA
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 1:1131 BROADWAY AVE.
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14212-1501
Mailing Address - Country:US
Mailing Address - Phone:716-896-7350
Mailing Address - Fax:
Practice Address - Street 1:1131 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-1501
Practice Address - Country:US
Practice Address - Phone:716-896-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral