Provider Demographics
NPI:1902119589
Name:HOGAN, SUSAN ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST FL 4
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:79 BEACON ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-3424
Practice Address - Country:US
Practice Address - Phone:203-574-9000
Practice Address - Fax:203-574-9006
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0062941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherOPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY
CT060669107OtherUNITED HEALTHCARE/UBH WELLMORE GRP/FACILITY
CT475346 PENDINGOtherMHN TRICARENORTH
CT060669107OtherCONNECTICARE/UBH WELLMORE GRP/FACILITY
CTPENDINGMedicaid
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT475346 PENDINGOtherMHN MANAGED HEALTH NETWORK
CT12149987OtherCAQH
CT060669107OtherAETNA BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT060669107OtherOXFORD HEALTH/FREEDOM PLAN-UBH WELLMORE GRP/FACILITY
CT060669107OtherOXFORD HEALTH/FREEDOM PLAN-UBH WELLMORE GRP/FACILITY
CT12149987OtherCAQH
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY