Provider Demographics
NPI:1396442380
Name:HODGES, MORGAN
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 STATE RT 34-
Mailing Address - Street 2:BUILDING 3-SUITE 301B
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:732-749-8317
Mailing Address - Fax:732-749-8318
Practice Address - Street 1:1800 STATE RT 34-
Practice Address - Street 2:BUILDING 3-SUITE 301B
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719
Practice Address - Country:US
Practice Address - Phone:732-749-8317
Practice Address - Fax:732-749-8318
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ106S00000X
NJRBT-22-235493106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0991937Medicaid