MEDICARE: TRACEY E HAGAN LCSW-A

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	1041C0700X	Clinical Social Worker	P021903	NC

General Provider Information

NPI Number	:	1477437259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY E HAGAN LCSW-A

Provider Business Mailing Address
First Line	:	7228 NC HIGHWAY 49 N
Second Line	:
City	:	LIBERTY
State	:	NC
Zip	:	27298-8264
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3013 S CHURCH ST
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5154
Country	:	US
Telephone Number	:	336-447-7235
Fax Number	:

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

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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Directions to “ TRACEY E HAGAN LCSW-A” Practice Location

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