Healthcare Provider Details

I. General information

NPI: 1164037792
Provider Name (Legal Business Name): JASON HENRY HOAG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INDEPENDENCE DR UNIT 8
HYANNIS MA
02601-1898
US

IV. Provider business mailing address

8 COMPASS CIR
EAST FALMOUTH MA
02536-4705
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-1839
  • Fax:
Mailing address:
  • Phone: 415-828-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: