Provider Demographics
NPI:1386336063
Name:BOEGEHOLD, STEPHEN THOMAS
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:THOMAS
Last Name:BOEGEHOLD
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 1:554 44TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-1305
Mailing Address - Country:US
Mailing Address - Phone:586-817-1232
Mailing Address - Fax:
Practice Address - Street 1:192 THROOP AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:929-210-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health