Provider Demographics
NPI:1407516503
Name:BOGDEN, AMY LOUISE (LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:BOGDEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 QUEEN AVE
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-2348
Mailing Address - Country:US
Mailing Address - Phone:717-525-2019
Mailing Address - Fax:
Practice Address - Street 1:8 W SNYDER ST
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1504
Practice Address - Country:US
Practice Address - Phone:570-259-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001222106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist