Healthcare Provider Details

I. General information

NPI: 1235265604
Provider Name (Legal Business Name): CHRISTA NOELLE HOGAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 06/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 BAY AVE STE 2
POINT PLEASANT BORO NJ
08742-4502
US

IV. Provider business mailing address

19 FREDE DR
BRICK NJ
08724-4016
US

V. Phone/Fax

Practice location:
  • Phone: 732-899-0701
  • Fax: 732-899-6962
Mailing address:
  • Phone: 732-899-7735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05270600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: