Provider Demographics
NPI:1528584893
Name:BOGAERT, JENNIE (LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:BOGAERT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1528
Mailing Address - Country:US
Mailing Address - Phone:508-366-1564
Mailing Address - Fax:
Practice Address - Street 1:CHILD THERAPY BOSTON 4 BELLOWS RD.
Practice Address - Street 2:SUITE C
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-0158
Practice Address - Country:US
Practice Address - Phone:508-904-8103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health