Provider Demographics
NPI:1265468003
Name:BOGOVICH, KRISTINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:BOGOVICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 FORBES AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-1622
Mailing Address - Country:US
Mailing Address - Phone:412-765-1665
Mailing Address - Fax:
Practice Address - Street 1:429 FORBES AVE
Practice Address - Street 2:SUITE 1614
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-1622
Practice Address - Country:US
Practice Address - Phone:412-765-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003257L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABO 069538Medicare ID - Type Unspecified