Provider Demographics
NPI:1710049440
Name:HOGAN, CARRIE ELLEN (LMT)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ELLEN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BITTERSWEET LN
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9425
Mailing Address - Country:US
Mailing Address - Phone:518-439-2209
Mailing Address - Fax:
Practice Address - Street 1:15 BITTERSWEET LN
Practice Address - Street 2:
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9425
Practice Address - Country:US
Practice Address - Phone:518-439-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015483174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist