Provider Demographics
NPI:1508391848
Name:BOGITA, PENINA (NCC, LACMH)
Entity Type:Individual
Prefix:
First Name:PENINA
Middle Name:
Last Name:BOGITA
Suffix:
Gender:F
Credentials:NCC, LACMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LISA DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3754
Mailing Address - Country:US
Mailing Address - Phone:302-765-7464
Mailing Address - Fax:
Practice Address - Street 1:252 CARTER DR STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5858
Practice Address - Country:US
Practice Address - Phone:302-449-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEAC-0000124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health