Provider Demographics
NPI:1235852369
Name:BOGART, SHLOMO (LPCA)
Entity Type:Individual
Prefix:MR
First Name:SHLOMO
Middle Name:
Last Name:BOGART
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:SOLOMON
Other - Middle Name:
Other - Last Name:BOGART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1066 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-3463
Mailing Address - Country:US
Mailing Address - Phone:646-763-1424
Mailing Address - Fax:
Practice Address - Street 1:1844 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1400
Practice Address - Country:US
Practice Address - Phone:203-407-1310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5384101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor