Provider Demographics
NPI:1528111457
Name:BOKLAGA, SUSAN (LMHC, LLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BOKLAGA
Suffix:
Gender:F
Credentials:LMHC, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6274
Mailing Address - Country:US
Mailing Address - Phone:561-630-2784
Mailing Address - Fax:561-630-9098
Practice Address - Street 1:4360 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6274
Practice Address - Country:US
Practice Address - Phone:561-630-2784
Practice Address - Fax:561-630-9098
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health