Provider Demographics
NPI:1093899668
Name:HOGE, WENDY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:HOGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:HOGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW LLC
Mailing Address - Street 1:433 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1659
Mailing Address - Country:US
Mailing Address - Phone:207-363-9299
Mailing Address - Fax:207-363-9299
Practice Address - Street 1:433 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1659
Practice Address - Country:US
Practice Address - Phone:207-363-9299
Practice Address - Fax:207-363-9299
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC38441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
026893OtherTRICARE
026893OtherVALUE OPTIONS
NH14Y000792ME02OtherANTHEM
ME214400000Medicaid
270558OtherMAGELLAN
ME048662OtherANTHEM
MEMM4717Medicare ID - Type Unspecified