Provider Demographics
NPI:1326133729
Name:HOGE, SUSAN S (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:HOGE
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 1:300 WEST MAIN STREET
Mailing Address - Street 2:FOX MEADOWS, BLDG B
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532
Mailing Address - Country:US
Mailing Address - Phone:508-393-1337
Mailing Address - Fax:508-393-1387
Practice Address - Street 1:300 WEST MAIN STREET
Practice Address - Street 2:FOX MEADOWS, BLDG B
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532
Practice Address - Country:US
Practice Address - Phone:508-393-1337
Practice Address - Fax:508-393-1387
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7675103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO6203OtherBLUE CROSS
MAWO6203OtherBLUE CROSS