Provider Demographics
NPI:1528892973
Name:HAGLER, LILLIANNA DOMINQUE
Entity type:Individual
Prefix:MISS
First Name:LILLIANNA
Middle Name:DOMINQUE
Last Name:HAGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HASTINGS ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2636
Mailing Address - Country:US
Mailing Address - Phone:978-418-3012
Mailing Address - Fax:
Practice Address - Street 1:48 HASTINGS ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2636
Practice Address - Country:US
Practice Address - Phone:978-418-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician