Healthcare Provider Details

I. General information

NPI: 1083500359
Provider Name (Legal Business Name): JEFFREY HAGLE ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 E 3RD ST APT 303
LONG BEACH CA
90814-6196
US

IV. Provider business mailing address

4266 PACIFIC AVE
LONG BEACH CA
90807-1924
US

V. Phone/Fax

Practice location:
  • Phone: 562-607-1574
  • Fax: 213-444-3819
Mailing address:
  • Phone: 562-607-1574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberACSW11452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: