Provider Demographics
NPI:1124100409
Name:FOGEL, HANNA (LMFT, LMHC)
Entity type:Individual
Prefix:MRS
First Name:HANNA
Middle Name:
Last Name:FOGEL
Suffix:
Gender:F
Credentials:LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 NEWBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2645
Mailing Address - Country:US
Mailing Address - Phone:617-558-1364
Mailing Address - Fax:617-558-1365
Practice Address - Street 1:124 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6478
Practice Address - Country:US
Practice Address - Phone:617-901-7300
Practice Address - Fax:617-558-1365
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5681101YM0800X
MA1124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist