Provider Demographics
NPI:1124141593
Name:HAGER, JEAN E (,LCSW,LCADC)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:HAGER
Suffix:
Gender:F
Credentials:,LCSW,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 SHREWSBURY AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3006
Mailing Address - Country:US
Mailing Address - Phone:732-747-2055
Mailing Address - Fax:732-747-6155
Practice Address - Street 1:776 SHREWSBURY AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3006
Practice Address - Country:US
Practice Address - Phone:732-747-2055
Practice Address - Fax:732-747-6155
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003591001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical