Jayne D. Hagen, PH.D

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY22689 Issued in CA

Practice address

1213 Masonic Ave
Berkeley, CA 94706

Phone

(510) 778-4055

NPI assigned

Jun 23, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jayne D Hagen

  • Clinical Neuropsychologist
  • Berkeley, CA
  • NPI 1770122178
  NPD Authorized official
• Brian Wu MD PHD Inc

  • Psychiatry Physician
  • San Gabriel, CA
  • NPI 1528639481
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1104087071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 MASONIC AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947062329",
            "telephone_number": "510-778-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 MASONIC AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "94706",
            "telephone_number": "510-778-4055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11835 W Olympic Blvd Ste 1265E",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "90064",
            "country_code": "US",
            "telephone_number": "310-273-4843",
            "fax_number": "310-273-5056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "JAYNE",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-23",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY22689",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY22689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Marie Hackett, PMHNP-BC, BSN, RN
• Gunilla Haegerstrom-Portnoy, OD, PHD
• Daniel Hagan, LMFT
• Shannon Hagan
• Stephanie Hage
• Sonya Marie Haggett, ASW
• Steven Nicholas Haight
• Christian Vernon Hailozian, PHARMD
• Erin Hajre Chapman, IBCLC
• Ali Hakimi, L.AC.

• Clinical Neuropsychologist in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.