Provider Demographics
NPI:1346970118
Name:BOGGIO, DANA (MFT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BOGGIO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 E BROADWAY STE 12
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5817
Mailing Address - Country:US
Mailing Address - Phone:323-246-5277
Mailing Address - Fax:
Practice Address - Street 1:3233 E BROADWAY STE 12
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5817
Practice Address - Country:US
Practice Address - Phone:323-246-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131936106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty