MEDICARE: MONA ELAINE HOGAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker	89985	CA

General Provider Information

NPI Number	:	1063891299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONA ELAINE HOGAN LCSW

Provider Business Mailing Address
First Line	:	41990 COOK ST STE 801A
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6103
Country	:	US
Telephone Number	:	760-443-1416
Fax Number	:	760-616-7035

Provider Business Practice Location Address
First Line	:	41990 COOK ST STE 801A
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6103
Country	:	US
Telephone Number	:	760-443-1416
Fax Number	:	760-616-7035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	09/03/2020

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