Provider Demographics
NPI:1003885260
Name:MOGAN, SARA J (LICSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:MOGAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MECHANIC STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035
Mailing Address - Country:US
Mailing Address - Phone:508-543-2133
Mailing Address - Fax:
Practice Address - Street 1:95 WEST STREET
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081
Practice Address - Country:US
Practice Address - Phone:508-660-1510
Practice Address - Fax:508-660-3122
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA213400OtherLICENSE