Healthcare Provider Details

I. General information

NPI: 1447451372
Provider Name (Legal Business Name): DENNIS PATRICK HAGERTY M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43807 10TH ST W STE D
LANCASTER CA
93534-4805
US

IV. Provider business mailing address

447 N EL MOLINO AVE
PASADENA CA
91101-1403
US

V. Phone/Fax

Practice location:
  • Phone: 661-575-9365
  • Fax:
Mailing address:
  • Phone: 626-577-8480
  • Fax: 626-577-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number80448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: