Provider Demographics
NPI:1912051053
Name:HAGEMANN, VICTORIA JOY (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:JOY
Last Name:HAGEMANN
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:JOY
Other - Last Name:HAGEMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWR
Mailing Address - Street 1:548 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2429
Mailing Address - Country:US
Mailing Address - Phone:516-384-0967
Mailing Address - Fax:
Practice Address - Street 1:11 HIGHT STREET
Practice Address - Street 2:
Practice Address - City:EAST WILLISTON
Practice Address - State:NY
Practice Address - Zip Code:11596
Practice Address - Country:US
Practice Address - Phone:516-384-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057842 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR0578421OtherEDUCATION DEP OFFICE OF P