Provider Demographics
NPI:1801248760
Name:HAGERMANN, RAYMOND EDWARD III (LMSW)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:EDWARD
Last Name:HAGERMANN
Suffix:III
Gender:M
Credentials:LMSW
Other - Prefix:MR
Other - First Name:RAYMOND
Other - Middle Name:EDWARD
Other - Last Name:TAEGER
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:163 PRESTON AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3653
Mailing Address - Country:US
Mailing Address - Phone:248-390-3025
Mailing Address - Fax:
Practice Address - Street 1:2449 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5647
Practice Address - Country:US
Practice Address - Phone:586-510-4992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011044881041C0700X
MI68010995471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical