Provider Demographics
NPI:1619927555
Name:KOGAN, LAURA GWEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:GWEN
Last Name:KOGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 TAMARACK CIR
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2020
Mailing Address - Country:US
Mailing Address - Phone:609-688-1244
Mailing Address - Fax:
Practice Address - Street 1:98 TAMARACK CIR
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2020
Practice Address - Country:US
Practice Address - Phone:609-688-1244
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00282300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ142017Medicare ID - Type Unspecified