Provider Demographics
NPI:1407049786
Name:O'HAGEN, SEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:O'HAGEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MAIN ST LBBY LVL
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1548
Mailing Address - Country:US
Mailing Address - Phone:607-205-1394
Mailing Address - Fax:607-238-3749
Practice Address - Street 1:231 MAIN ST LBBY LVL
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1548
Practice Address - Country:US
Practice Address - Phone:607-205-1394
Practice Address - Fax:607-238-3749
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019322103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist