Provider Demographics
NPI:1518260678
Name:HAGSTRAND, ANA MARIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:MARIA
Last Name:HAGSTRAND
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2604
Mailing Address - Country:US
Mailing Address - Phone:215-554-1876
Mailing Address - Fax:
Practice Address - Street 1:100 S BROAD ST
Practice Address - Street 2:SUITE 1215
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110-1023
Practice Address - Country:US
Practice Address - Phone:215-554-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016916103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical