Provider Demographics
NPI:1336287747
Name:HAGAN, MICHELINE S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELINE
Middle Name:S
Last Name:HAGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MADBURY ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824
Mailing Address - Country:US
Mailing Address - Phone:603-451-6970
Mailing Address - Fax:
Practice Address - Street 1:20 MADBURY ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824
Practice Address - Country:US
Practice Address - Phone:603-451-6970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1398103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical