Provider Demographics
NPI:1265997365
Name:HAGE, DAVID (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:HAGE
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 MEMORIAL HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9203
Mailing Address - Country:US
Mailing Address - Phone:570-285-8001
Mailing Address - Fax:570-285-8001
Practice Address - Street 1:3154 MEMORIAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9203
Practice Address - Country:US
Practice Address - Phone:570-285-8001
Practice Address - Fax:570-285-8001
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0199281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical