Provider Demographics
NPI:1194870329
Name:HAGER, JOANNE L (PHD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:L
Last Name:HAGER
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:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-0012
Mailing Address - Country:US
Mailing Address - Phone:508-362-0030
Mailing Address - Fax:508-362-0030
Practice Address - Street 1:9 OLD CASTLE RD
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-1535
Practice Address - Country:US
Practice Address - Phone:508-362-0030
Practice Address - Fax:508-362-0030
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1822103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02260OtherBCBS OF MA PROVIDER #
MA1822OtherMASS. PSYCHOLOGY LICENSE
MAW50591Medicare ID - Type UnspecifiedMEDICARE PROVIDER #