Provider Demographics
NPI:1770090763
Name:HAGAN, FREDERICK (LPC)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:HAGAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 FARRAGUT CT
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1822
Mailing Address - Country:US
Mailing Address - Phone:215-378-3392
Mailing Address - Fax:
Practice Address - Street 1:821 HUNTINGDON PIKE STE 140
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8368
Practice Address - Country:US
Practice Address - Phone:215-914-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6366101YA0400X
PAPC008449101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)