Provider Demographics
NPI:1770775942
Name:HOGGARD, DONNA DINKINS (LCSW, RN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:DINKINS
Last Name:HOGGARD
Suffix:
Gender:F
Credentials:LCSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 MAIN ST FL 2
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2845
Mailing Address - Country:US
Mailing Address - Phone:860-347-6971
Mailing Address - Fax:
Practice Address - Street 1:134 STATE ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-3293
Practice Address - Country:US
Practice Address - Phone:203-237-2229
Practice Address - Fax:203-686-1677
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR45327163W00000X
CT0080771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236338Medicaid