Provider Demographics
NPI:1730215104
Name:GROGAN, ANN HOLLINGER (LCSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:HOLLINGER
Last Name:GROGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ROUTE 1
Mailing Address - Street 2:SUITE 21B
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-4711
Mailing Address - Country:US
Mailing Address - Phone:207-846-0160
Mailing Address - Fax:207-846-0160
Practice Address - Street 1:500 ROUTE 1
Practice Address - Street 2:SUITE 21B
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-4711
Practice Address - Country:US
Practice Address - Phone:207-846-0160
Practice Address - Fax:207-846-0160
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC13171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8753Medicare ID - Type Unspecified