Provider Demographics
NPI:1528541240
Name:BOGSTED, CHANA RIVKA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CHANA
Middle Name:RIVKA
Last Name:BOGSTED
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-4505
Mailing Address - Country:US
Mailing Address - Phone:508-243-3190
Mailing Address - Fax:
Practice Address - Street 1:254A 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2811
Practice Address - Country:US
Practice Address - Phone:781-455-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10226571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical