Provider Demographics
NPI:1427783232
Name:HEGARTY, MICHAEL RAYMOND
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:HEGARTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 POTRERO AVENUE
Mailing Address - Street 2:BUILDING 90, 5TH FLOOR (WD95)
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1509
Mailing Address - Country:US
Mailing Address - Phone:628-206-3848
Mailing Address - Fax:
Practice Address - Street 1:995 POTRERO AVENUE
Practice Address - Street 2:BUILDING 90, 5TH FLOOR (WD95)
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1509
Practice Address - Country:US
Practice Address - Phone:628-206-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1475550722172V00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker