Healthcare Provider Details

I. General information

NPI: 1821199365
Provider Name (Legal Business Name): SCOTTY THOMAS HAGAN M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2327 TALL OAK DR
CANTONMENT FL
32533-2932
US

IV. Provider business mailing address

2327 TALL OAK DR
CANTONMENT FL
32533-2932
US

V. Phone/Fax

Practice location:
  • Phone: 850-602-8310
  • Fax:
Mailing address:
  • Phone: 850-602-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06461
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW27097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: