Provider Demographics
NPI:1922327261
Name:HAGER, KIM M (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:M
Last Name:HAGER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:MALENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:135 GOLD STAR BLVD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2738
Mailing Address - Country:US
Mailing Address - Phone:508-459-6400
Mailing Address - Fax:508-849-5618
Practice Address - Street 1:135 GOLD STAR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2738
Practice Address - Country:US
Practice Address - Phone:508-459-6400
Practice Address - Fax:508-849-5618
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1170951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical