Provider Demographics
NPI:1447596721
Name:BOGDA, PAIGE (LMFT)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:BOGDA
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 1:360B QUEEN ST # 175
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1871
Mailing Address - Country:US
Mailing Address - Phone:860-334-7093
Mailing Address - Fax:
Practice Address - Street 1:1492 FLANDERS RD
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1604
Practice Address - Country:US
Practice Address - Phone:860-334-7093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1743106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist