Provider Demographics
NPI:1891065942
Name:HAGBORG, WINSTON JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:JAMES
Last Name:HAGBORG
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 1:18 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:WEST SAND LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12196-2601
Mailing Address - Country:US
Mailing Address - Phone:518-283-4825
Mailing Address - Fax:
Practice Address - Street 1:50 WOODBRIDGE AVE.
Practice Address - Street 2:CHATHAM CENTRAL SCHOOL
Practice Address - City:CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12037-1317
Practice Address - Country:US
Practice Address - Phone:518-392-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009707103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist