MEDICARE: DR. JOANNE L. HAGER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	1822	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W02260	OTHER	MA	BCBS OF MA PROVIDER #
2	1822	OTHER	MA	MASS. PSYCHOLOGY LICENSE

General Provider Information

NPI Number	:	1194870329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNE L. HAGER PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 12
Second Line	:
City	:	YARMOUTH PORT
State	:	MA
Zip	:	02675-0012
Country	:	US
Telephone Number	:	508-362-0030
Fax Number	:	508-362-0030

Provider Business Practice Location Address
First Line	:	9 OLD CASTLE RD
Second Line	:
City	:	YARMOUTH PORT
State	:	MA
Zip	:	02675-1535
Country	:	US
Telephone Number	:	508-362-0030
Fax Number	:	508-362-0030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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