Provider Demographics
NPI:1497879464
Name:BOGAS, SUSAN M (SUSAN BOGAS,PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:BOGAS
Suffix:
Gender:F
Credentials:SUSAN BOGAS,PHD
Other - Prefix:DR
Other - First Name:BOGAS
Other - Middle Name:M
Other - Last Name:BOGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:601 EWING ST
Mailing Address - Street 2:SUITE C9
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2757
Mailing Address - Country:US
Mailing Address - Phone:609-683-4282
Mailing Address - Fax:609-924-8172
Practice Address - Street 1:601 EWING ST
Practice Address - Street 2:SUITE C9
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2757
Practice Address - Country:US
Practice Address - Phone:609-683-4282
Practice Address - Fax:609-924-8172
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI01618103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBO531691Medicare ID - Type Unspecified