Provider Demographics
NPI:1164102315
Name:FOGAH, HERMAN LIVINGSTON JR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:LIVINGSTON
Last Name:FOGAH
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9609 66TH AVE APT 4E
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4113
Mailing Address - Country:US
Mailing Address - Phone:718-710-1960
Mailing Address - Fax:
Practice Address - Street 1:9609 66TH AVE APT 4E
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4113
Practice Address - Country:US
Practice Address - Phone:718-710-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102281104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker