Provider Demographics
NPI:1205032521
Name:HOAG, NANCY LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LEE
Last Name:HOAG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 ROXBURY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-3832
Mailing Address - Country:US
Mailing Address - Phone:518-851-2173
Mailing Address - Fax:518-851-3757
Practice Address - Street 1:94 ROXBURY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-3832
Practice Address - Country:US
Practice Address - Phone:518-851-2173
Practice Address - Fax:518-851-3757
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011430-1103TC0700X, 103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities