Basic Information
| Provider Information | |||||||||
| NPI: | 1558972018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOGAN | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | DOROTHY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3962 BEECHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945191256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102258756 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1861 SILVERWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945191352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256870202 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2020 | ||||||||
| LastUpdateDate: | 11/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 26797 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 98375 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.