Provider Demographics
NPI:1710223169
Name:HOGAN, MARITZA AMINTA (PHD)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:AMINTA
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 N HARVIN ST FL 6
Mailing Address - Street 2:SC DEPARTMENT OF JUVENILE JUSTICE
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4956
Mailing Address - Country:US
Mailing Address - Phone:803-778-2368
Mailing Address - Fax:803-775-2377
Practice Address - Street 1:115 N HARVIN ST FL 6
Practice Address - Street 2:SC DEPARTMENT OF JUVENILE JUSTICE
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4956
Practice Address - Country:US
Practice Address - Phone:803-778-2368
Practice Address - Fax:803-775-2377
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist