Provider Demographics
NPI:1043315963
Name:HAGOVSKY, MATHIAS R (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATHIAS
Middle Name:R
Last Name:HAGOVSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5604
Mailing Address - Country:US
Mailing Address - Phone:973-994-3145
Mailing Address - Fax:973-994-9152
Practice Address - Street 1:22 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 216
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5604
Practice Address - Country:US
Practice Address - Phone:973-994-3145
Practice Address - Fax:973-994-9152
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00141500103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic