Provider Demographics
NPI:1912125519
Name:HODGES, MOTONI FONG (PHD)
Entity Type:Individual
Prefix:DR
First Name:MOTONI
Middle Name:FONG
Last Name:HODGES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 W 49TH ST
Mailing Address - Street 2:2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7216
Mailing Address - Country:US
Mailing Address - Phone:212-956-9749
Mailing Address - Fax:
Practice Address - Street 1:144 W 86TH ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4028
Practice Address - Country:US
Practice Address - Phone:917-514-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017126103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis