Provider Demographics
NPI:1669463808
Name:HAGEMAN, ROXANNA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROXANNA
Middle Name:
Last Name:HAGEMAN
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 1:5 GOVERNORS LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-5504
Mailing Address - Country:US
Mailing Address - Phone:530-899-0148
Mailing Address - Fax:415-846-4449
Practice Address - Street 1:5 GOVERNORS LN
Practice Address - Street 2:SUITE A
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-5504
Practice Address - Country:US
Practice Address - Phone:530-899-0148
Practice Address - Fax:415-846-4449
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 179641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ13486ZMedicare ID - Type UnspecifiedPROVIDER