Provider Demographics
NPI:1659403053
Name:BOGADO, KATHLEEN K (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:K
Last Name:BOGADO
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11106 RALSTON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3665
Mailing Address - Country:US
Mailing Address - Phone:301-897-5588
Mailing Address - Fax:301-897-5639
Practice Address - Street 1:11106 RALSTON RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3665
Practice Address - Country:US
Practice Address - Phone:301-897-5588
Practice Address - Fax:301-897-5639
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD647049Medicare ID - Type Unspecified