Provider Demographics
NPI:1417171810
Name:HOGAN, PATRICIA F (LCSW, LMT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:F
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LCSW, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:ST MICHAELS
Mailing Address - State:AZ
Mailing Address - Zip Code:86511-0100
Mailing Address - Country:US
Mailing Address - Phone:928-871-2899
Mailing Address - Fax:928-871-4873
Practice Address - Street 1:MUSTANG ROAD 1 MILE NORTH OF RT 264
Practice Address - Street 2:ST MICHAELS ASSOC FOR SPECIAL EDUCATION
Practice Address - City:ST MICHAELS
Practice Address - State:AZ
Practice Address - Zip Code:86511-0100
Practice Address - Country:US
Practice Address - Phone:928-871-2899
Practice Address - Fax:928-871-4873
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-120721041C0700X
CT0016961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical