Provider Demographics
NPI:1568006880
Name:BOGRETTE, PATRICIA (MED, LBS, BCBA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BOGRETTE
Suffix:
Gender:F
Credentials:MED, LBS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 N LINGLE AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1144
Mailing Address - Country:US
Mailing Address - Phone:717-648-0530
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:125 SCHNEIDER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-4875
Practice Address - Country:US
Practice Address - Phone:717-270-2444
Practice Address - Fax:717-270-2472
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001883103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
12700712OtherCAQH ID #
PABH001883OtherSTATE LICENSE