Provider Demographics
NPI:1174148290
Name:HOGAN, JACQUELINE S (PHD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:S
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:112 PARKER ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-4008
Mailing Address - Country:US
Mailing Address - Phone:978-488-1364
Mailing Address - Fax:
Practice Address - Street 1:112 PARKER ST STE 2A
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-4008
Practice Address - Country:US
Practice Address - Phone:978-488-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC10000946103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist