Provider Demographics
NPI:1083672158
Name:BOGART, KAREN (MS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BOGART
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N PARK AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3242
Mailing Address - Country:US
Mailing Address - Phone:407-629-1775
Mailing Address - Fax:
Practice Address - Street 1:515 N PARK AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3242
Practice Address - Country:US
Practice Address - Phone:407-629-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2575101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health