Provider Demographics
NPI:1720091184
Name:HOGAN, CHARLES HENRY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HENRY
Last Name:HOGAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHESTNUT ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2576
Mailing Address - Country:US
Mailing Address - Phone:781-449-4073
Mailing Address - Fax:781-453-8824
Practice Address - Street 1:20 CHESTNUT ST
Practice Address - Street 2:SUITE 7
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2576
Practice Address - Country:US
Practice Address - Phone:781-449-4073
Practice Address - Fax:781-453-8824
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4965103TH0100X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA052559000OtherMAGELLAN BEHAVIORAL HEALT
MAWO4683OtherBLUE CROSS/BLUE SHIELD
MAHARVARD PILGRIM HEALOther32380
MA721268OtherTUFTS HEALTH PLAN
MAHARVARD PILGRIM HEALOther32380