Provider Demographics
NPI:1588999858
Name:BOGIE, JANETTE (MSED, MPHILED)
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:
Last Name:BOGIE
Suffix:
Gender:F
Credentials:MSED, MPHILED
Other - Prefix:
Other - First Name:JANETTE
Other - Middle Name:
Other - Last Name:JESSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, MPHILED
Mailing Address - Street 1:2001 W BLUE HERON BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-5003
Mailing Address - Country:US
Mailing Address - Phone:561-841-3500
Mailing Address - Fax:561-844-3577
Practice Address - Street 1:2001 W BLUE HERON BLVD
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-5003
Practice Address - Country:US
Practice Address - Phone:561-841-3500
Practice Address - Fax:561-844-3577
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006550400Medicaid