Healthcare Provider Details

I. General information

NPI: 1538324934
Provider Name (Legal Business Name): SHARON J HAGEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 OUTLOOK HEIGHTS CT
PACIFICA CA
94044-2174
US

IV. Provider business mailing address

217 OUTLOOK HEIGHTS CT
PACIFICA CA
94044-2174
US

V. Phone/Fax

Practice location:
  • Phone: 650-355-2968
  • Fax: 650-355-2968
Mailing address:
  • Phone: 650-355-2968
  • Fax: 650-355-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6881
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: