Provider Demographics
NPI:1639544075
Name:BOGOSIAN, MAUREEN D (ADC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:D
Last Name:BOGOSIAN
Suffix:
Gender:F
Credentials:ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 474
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER
Mailing Address - State:VT
Mailing Address - Zip Code:05001
Mailing Address - Country:US
Mailing Address - Phone:802-281-5213
Mailing Address - Fax:
Practice Address - Street 1:211 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER
Practice Address - State:VT
Practice Address - Zip Code:05001
Practice Address - Country:US
Practice Address - Phone:603-252-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104264101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)