Provider Demographics
NPI:1083815187
Name:HAJEK, AGNES NICOLAS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:NICOLAS
Last Name:HAJEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:AGNES
Other - Middle Name:NICOLAS
Other - Last Name:BUZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:164 DAY ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-0106
Mailing Address - Country:US
Mailing Address - Phone:760-822-2076
Mailing Address - Fax:
Practice Address - Street 1:2160 FLETCHER PKWY STE 102
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2117
Practice Address - Country:US
Practice Address - Phone:760-822-2076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10638-61041C0700X
CA824031041C0700X
CALCSW824031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical