Provider Demographics
NPI:1316296445
Name:HAGEL, KATRIN MARGRIT (MA)
Entity type:Individual
Prefix:
First Name:KATRIN MARGRIT
Middle Name:
Last Name:HAGEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARGRIT
Other - Middle Name:
Other - Last Name:HAGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1500 PETALUMA BLVD S
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5545
Mailing Address - Country:US
Mailing Address - Phone:707-765-8488
Mailing Address - Fax:707-765-8482
Practice Address - Street 1:3164 CONDO CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-360-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105747106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist