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Individual
SAGE IMOGENE PHOENIX
Active
Individual
SAGE IMOGENE PHOENIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC (MA #9606)
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
9606
MA
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110026265E
—
MA
Enumeration date
12/13/2012
Last updated
03/06/2025
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