Healthcare Provider Details

I. General information

NPI: 1649180068
Provider Name (Legal Business Name): LAUREN HAGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 AMERICAN LEGION HWY
ROSLINDALE MA
02131-3908
US

IV. Provider business mailing address

1657 COMMONWEALTH AVE APT 7
BRIGHTON MA
02135-4944
US

V. Phone/Fax

Practice location:
  • Phone: 617-437-8612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: