Provider Demographics
NPI:1093992091
Name:BOGGAN, SHELLEY E (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:E
Last Name:BOGGAN
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 1:1300 BRUCE B DOWNS BLVD
Mailing Address - Street 2:SOCIAL WORK SERVICES
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9217
Mailing Address - Country:US
Mailing Address - Phone:813-972-2000
Mailing Address - Fax:813-903-2429
Practice Address - Street 1:1300 BRUCE B DOWNS BLVD
Practice Address - Street 2:SOCIAL WORK SERVICES
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9217
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-903-2429
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW81891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical