MEDICARE: MS. PATRICIA F HOGAN LCSW, LMT

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	1041C0700X	Clinical Social Worker	LCSW-12072	AZ
2	1041C0700X	Clinical Social Worker	001696	CT

General Provider Information

NPI Number	:	1417171810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA F HOGAN LCSW, LMT

Provider Business Mailing Address
First Line	:	PO BOX 100
Second Line	:
City	:	ST MICHAELS
State	:	AZ
Zip	:	86511-0100
Country	:	US
Telephone Number	:	928-871-2899
Fax Number	:	928-871-4873

Provider Business Practice Location Address
First Line	:	MUSTANG ROAD 1 MILE NORTH OF RT 264
Second Line	:	ST MICHAELS ASSOC FOR SPECIAL EDUCATION
City	:	ST MICHAELS
State	:	AZ
Zip	:	86511-0100
Country	:	US
Telephone Number	:	928-871-2899
Fax Number	:	928-871-4873

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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