Provider Demographics
NPI:1689891384
Name:BOGYO, LOLA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOLA
Middle Name:C
Last Name:BOGYO
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:277 STATE ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5439
Mailing Address - Country:US
Mailing Address - Phone:207-990-2580
Mailing Address - Fax:207-990-1930
Practice Address - Street 1:277 STATE ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5439
Practice Address - Country:US
Practice Address - Phone:207-990-2580
Practice Address - Fax:207-990-1930
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPS1251103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1689891384OtherANTHEM