Provider Demographics
NPI:1023167319
Name:HAGA, JILL V (MSW, LPC)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:V
Last Name:HAGA
Suffix:
Gender:F
Credentials:MSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 ROCKLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1550
Mailing Address - Country:US
Mailing Address - Phone:860-644-5215
Mailing Address - Fax:
Practice Address - Street 1:287 BILTON RD
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:CT
Practice Address - Zip Code:06071-1044
Practice Address - Country:US
Practice Address - Phone:860-763-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT001746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical