Provider Demographics
NPI:1699249482
Name:HOGAN, MICHAEL SEAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SEAN
Last Name:HOGAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7704 MCCALLUM ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-4308
Mailing Address - Country:US
Mailing Address - Phone:267-625-7950
Mailing Address - Fax:
Practice Address - Street 1:7704 MCCALLUM ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-4308
Practice Address - Country:US
Practice Address - Phone:267-625-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018936103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist