Provider Demographics
NPI:1225702483
Name:HOGAN, ANGELA M (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
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 1:103 ALLIE CT
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9189
Mailing Address - Country:US
Mailing Address - Phone:502-203-6951
Mailing Address - Fax:502-331-6062
Practice Address - Street 1:103 ALLIE CT
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-9189
Practice Address - Country:US
Practice Address - Phone:502-203-6951
Practice Address - Fax:502-331-6062
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY262577101Y00000X
101YA0400X
KY2529541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100775610Medicaid