Provider Demographics
NPI:1780070250
Name:HAGAN, CORINNE E
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:E
Last Name:HAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 BLOOMFIELD RD.
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004
Mailing Address - Country:US
Mailing Address - Phone:502-234-7800
Mailing Address - Fax:
Practice Address - Street 1:1347 S 3RD ST
Practice Address - Street 2:101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-3306
Practice Address - Country:US
Practice Address - Phone:502-634-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6497104100000X
KY2530471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker