Healthcare Provider Details

I. General information

NPI: 1033380829
Provider Name (Legal Business Name): EMILY HOGAN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5115 BOX 48TH
APO AE
09461-5115
US

IV. Provider business mailing address

626 REVOLUTION STREET SUSQUEHANNA COUNSELING SERVICES LLC
HAVRE DE GRACE MD
21078
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15863
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: