Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 1822 | MA |
NPI | 1194870329 |
---|---|
Provider Name | Dr. Joanne L. Hager |
First Address | Yarmouth Port, MA 02675-0012 |
Second Address | Yarmouth Port, MA 02675-1535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1822 | MASS. PSYCHOLOGY LICENSE (01) | MA |
W02260 | BCBS OF MA PROVIDER # (01) | MA |