Provider Demographics
NPI:1518923366
Name:BOGERT, DAVID ERIC (MS, MBA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ERIC
Last Name:BOGERT
Suffix:
Gender:M
Credentials:MS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-2451
Mailing Address - Country:US
Mailing Address - Phone:321-284-1840
Mailing Address - Fax:321-284-1854
Practice Address - Street 1:3389 W VINE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4665
Practice Address - Country:US
Practice Address - Phone:321-284-1840
Practice Address - Fax:321-284-1854
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
593468490OtherAETNA