Provider Demographics
NPI:1962789818
Name:BOGER, PATRICIA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:BOGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 JACKSON RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:VA
Mailing Address - Zip Code:24465-0490
Mailing Address - Country:US
Mailing Address - Phone:540-468-3300
Mailing Address - Fax:540-465-3301
Practice Address - Street 1:120 JACKSON RIVER ROAD
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:VA
Practice Address - Zip Code:24465-0490
Practice Address - Country:US
Practice Address - Phone:540-468-3300
Practice Address - Fax:540-465-3301
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040019571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical