Provider Demographics
NPI:1376997452
Name:HAGEN, JEFFREY (LPC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:HAGEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 N RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1408
Mailing Address - Country:US
Mailing Address - Phone:267-255-4272
Mailing Address - Fax:
Practice Address - Street 1:8302 OLD YORK RD
Practice Address - Street 2:SUITE #12
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1522
Practice Address - Country:US
Practice Address - Phone:215-885-9700
Practice Address - Fax:215-886-7678
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional