Provider Demographics
NPI:1407008881
Name:BOGDANOFF, EMILY ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ROSE
Last Name:BOGDANOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:ROSE
Other - Last Name:BOGDANOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-6418
Mailing Address - Fax:808-433-4890
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-6418
Practice Address - Fax:808-433-4890
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18912103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical