Provider Demographics
NPI:1730746108
Name:HOGAN, TRACY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:AMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12017 SW BENNINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2723
Mailing Address - Country:US
Mailing Address - Phone:772-345-2223
Mailing Address - Fax:
Practice Address - Street 1:12017 SW BENNINGTON CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2723
Practice Address - Country:US
Practice Address - Phone:772-345-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW53771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical