Provider Demographics
NPI:1003980657
Name:HAGBERG, NILS (PHD)
Entity Type:Individual
Prefix:DR
First Name:NILS
Middle Name:
Last Name:HAGBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-4046
Mailing Address - Country:US
Mailing Address - Phone:510-530-6701
Mailing Address - Fax:510-531-1190
Practice Address - Street 1:6220 LA SALLE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2804
Practice Address - Country:US
Practice Address - Phone:510-530-6701
Practice Address - Fax:510-531-1190
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT15889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health