Provider Demographics
NPI:1851548333
Name:HAGEN, SUSAN DINGLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DINGLE
Last Name:HAGEN
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 1:7000 NW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2381
Mailing Address - Country:US
Mailing Address - Phone:561-368-0993
Mailing Address - Fax:561-391-5054
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 123
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-368-0993
Practice Address - Fax:561-391-5054
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7128103T00000X
IL71005313103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist