Provider Demographics
NPI:1063891299
Name:HOGAN, MONA ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:ELAINE
Last Name:HOGAN
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 1:41990 COOK ST STE 801A
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6103
Mailing Address - Country:US
Mailing Address - Phone:760-443-1416
Mailing Address - Fax:760-616-7035
Practice Address - Street 1:41990 COOK ST STE 801A
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6103
Practice Address - Country:US
Practice Address - Phone:760-443-1416
Practice Address - Fax:760-616-7035
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA899851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor