Provider Demographics
NPI:1902204175
Name:MOGREN, HALLORY (LMHC)
Entity Type:Individual
Prefix:
First Name:HALLORY
Middle Name:
Last Name:MOGREN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 HINCKLEY ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2541
Mailing Address - Country:US
Mailing Address - Phone:617-894-3088
Mailing Address - Fax:
Practice Address - Street 1:57 HINCKLEY ST # 1
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2541
Practice Address - Country:US
Practice Address - Phone:617-894-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8951101YM0800X
ORC3680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health