Provider Demographics
NPI:1720192289
Name:HAGBERG, FELICIA R (MSW)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:R
Last Name:HAGBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:FELICIA
Other - Middle Name:A
Other - Last Name:RAO HAGBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473-0412
Mailing Address - Country:US
Mailing Address - Phone:978-855-0645
Mailing Address - Fax:978-874-0419
Practice Address - Street 1:71 MAIN ST STE 2D
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1472
Practice Address - Country:US
Practice Address - Phone:978-855-0645
Practice Address - Fax:978-874-0419
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10157581041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08262OtherBXBS
MA1859391Medicaid
MAP08262OtherBXBS
MA968282OtherNETWORK HEALTH