Provider Demographics
NPI:1346338597
Name:HAGNER, EMILY JOAN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JOAN
Last Name:HAGNER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 EASTERLY ST
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1139
Mailing Address - Country:US
Mailing Address - Phone:518-773-3924
Mailing Address - Fax:
Practice Address - Street 1:142 EASTERLY ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1139
Practice Address - Country:US
Practice Address - Phone:518-773-3924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036719-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical