Healthcare Provider Details

I. General information

NPI: 1447079207
Provider Name (Legal Business Name): DANIEL HAGAN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 ASHBY AVE
BERKELEY CA
94705-2200
US

IV. Provider business mailing address

2615 ASHBY AVE
BERKELEY CA
94705-2200
US

V. Phone/Fax

Practice location:
  • Phone: 510-210-3640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT163055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: