Provider Demographics
NPI:1225491822
Name:ROBERT W. HAGEBAK, PH.D.
Entity Type:Organization
Organization Name:ROBERT W. HAGEBAK, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINSITRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:DILEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-692-9697
Mailing Address - Street 1:502 WOODLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-4659
Mailing Address - Country:US
Mailing Address - Phone:830-693-5360
Mailing Address - Fax:
Practice Address - Street 1:502 WOODLAND PARK DR
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4659
Practice Address - Country:US
Practice Address - Phone:830-693-5360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty