Provider Demographics
NPI:1730166786
Name:HOGAN, JULIAN BENNETT (RN LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIAN
Middle Name:BENNETT
Last Name:HOGAN
Suffix:
Gender:F
Credentials:RN LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1423
Mailing Address - Country:US
Mailing Address - Phone:845-691-8003
Mailing Address - Fax:845-691-8003
Practice Address - Street 1:62 MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1423
Practice Address - Country:US
Practice Address - Phone:845-691-8003
Practice Address - Fax:845-691-8003
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0457311104100000X
NY3627391163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02030486Medicaid