Provider Demographics
NPI:1417072315
Name:BOGART, CHRISTOPHER MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:BOGART
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 SOUTHFIELD AVE
Mailing Address - Street 2:BUILDING TWO, SUITE 160
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7237
Mailing Address - Country:US
Mailing Address - Phone:203-348-9920
Mailing Address - Fax:203-348-1838
Practice Address - Street 1:68 SOUTHFIELD AVE
Practice Address - Street 2:BUILDING TWO, SUITE 160
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-7237
Practice Address - Country:US
Practice Address - Phone:203-348-9920
Practice Address - Fax:203-348-1838
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001493103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist