Provider Demographics
NPI:1376978718
Name:HAGEN, JULIA H (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:H
Last Name:HAGEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SAINT JOHN ST STE 314
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3059
Mailing Address - Country:US
Mailing Address - Phone:508-314-3084
Mailing Address - Fax:
Practice Address - Street 1:222 ST JOHN ST SUITE 314
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2623
Practice Address - Country:US
Practice Address - Phone:508-314-3084
Practice Address - Fax:207-874-1044
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC146231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400172171Medicare PIN
MEE400132222Medicare PIN