Provider Demographics
NPI:1134468358
Name:HOGAN, BERNADETTE MARIE (PSYD)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:MARIE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 90TH ST
Mailing Address - Street 2:APT. 15K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1100
Mailing Address - Country:US
Mailing Address - Phone:212-787-7406
Mailing Address - Fax:
Practice Address - Street 1:250 W 90TH ST
Practice Address - Street 2:APT. 15K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1100
Practice Address - Country:US
Practice Address - Phone:212-787-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009711-1103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical