Provider Demographics
NPI:1700340940
Name:OGAGAN, INE D
Entity Type:Individual
Prefix:MS
First Name:INE
Middle Name:D
Last Name:OGAGAN
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 1:28 PERKINS ST APT 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1109
Mailing Address - Country:US
Mailing Address - Phone:508-965-2536
Mailing Address - Fax:
Practice Address - Street 1:280 MERRIMACK ST FL 3
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1779
Practice Address - Country:US
Practice Address - Phone:978-557-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical