Provider Demographics
NPI:1558342238
Name:HAGEROTT, KAREN (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:HAGEROTT
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 1:4501 WOODBINE ROAD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8706
Mailing Address - Country:US
Mailing Address - Phone:850-994-1205
Mailing Address - Fax:850-994-1206
Practice Address - Street 1:4501 WOODBINE ROAD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8706
Practice Address - Country:US
Practice Address - Phone:850-994-1205
Practice Address - Fax:850-994-1206
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP44571103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73828OtherBCBS