Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 021810 | NY |
Y | 103TC0700X | Clinical Psychologist | 021810 | NY |
NPI | 1003364753 |
---|---|
Provider Name | Lauren Hagemann |
First Address | Salem, VA 24153-6404 |
Second Address | Salem, VA 24153-6404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2016 |
Last Update Date | 12/09/2016 |