Provider Demographics
NPI:1184916751
Name:HAGE, SALLY (PHD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:HAGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-3707
Mailing Address - Country:US
Mailing Address - Phone:413-798-4818
Mailing Address - Fax:
Practice Address - Street 1:397 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5292
Practice Address - Country:US
Practice Address - Phone:413-798-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11468103TC1900X
NY018544103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018544OtherLICENSED PSYCHOLOGIST, STATE OF NEW YORK
MA11468OtherLICENSED PSYCHOLOGIST,