Provider Demographics
NPI:1104200781
Name:HOGAN, MARIAN JUSTINE SULLIVAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:JUSTINE SULLIVAN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:18217 HALE AVE
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-3550
Mailing Address - Country:US
Mailing Address - Phone:408-465-8280
Mailing Address - Fax:
Practice Address - Street 1:18217 HALE AVE
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-3550
Practice Address - Country:US
Practice Address - Phone:408-465-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA644611041C0700X
MA1156151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical