Provider Demographics
NPI:1497172878
Name:BOGEN, LESLIE (JD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:BOGEN
Suffix:
Gender:F
Credentials:JD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1912
Mailing Address - Country:US
Mailing Address - Phone:914-949-7699
Mailing Address - Fax:
Practice Address - Street 1:141 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1912
Practice Address - Country:US
Practice Address - Phone:914-949-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014130103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical