Provider Demographics
NPI:1346971942
Name:HAGER, KEITH (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:HAGER
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9259 LIBERTY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9589
Mailing Address - Country:US
Mailing Address - Phone:740-350-0413
Mailing Address - Fax:
Practice Address - Street 1:9259 LIBERTY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9589
Practice Address - Country:US
Practice Address - Phone:740-350-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.21067821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical