Provider Demographics
NPI:1326388620
Name:BOGGS, KAREN M (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:BOGGS
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 1:900 N SWALLOW TAIL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-6103
Mailing Address - Country:US
Mailing Address - Phone:386-333-9717
Mailing Address - Fax:386-333-9718
Practice Address - Street 1:900 N SWALLOW TAIL DR STE 105
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6103
Practice Address - Country:US
Practice Address - Phone:386-333-9717
Practice Address - Fax:386-333-9718
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LCSW101Y00000X
FLSW9350101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health