Provider Demographics
NPI:1558612879
Name:HOGG, SARA ELISABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:ELISABETH
Last Name:HOGG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:ELISABETH
Other - Last Name:CICCARIELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 914
Mailing Address - Street 2:
Mailing Address - City:MONTAUK
Mailing Address - State:NY
Mailing Address - Zip Code:11954-0702
Mailing Address - Country:US
Mailing Address - Phone:516-429-2608
Mailing Address - Fax:
Practice Address - Street 1:16 FLAMINGO COURT
Practice Address - Street 2:
Practice Address - City:MONTAUK
Practice Address - State:NY
Practice Address - Zip Code:11954-0702
Practice Address - Country:US
Practice Address - Phone:516-429-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07369411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical