Provider Demographics
NPI:1710490750
Name:INTERACTIVETRAININGASSOCIATES/EVE N. BOGDANOVE, LICSW
Entity Type:Organization
Organization Name:INTERACTIVETRAININGASSOCIATES/EVE N. BOGDANOVE, LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EVE
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOGDANOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LICSW
Authorized Official - Phone:413-325-1502
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01302-1011
Mailing Address - Country:US
Mailing Address - Phone:413-325-1502
Mailing Address - Fax:
Practice Address - Street 1:486 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3314
Practice Address - Country:US
Practice Address - Phone:413-325-1502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1103771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952568529OtherTUFTS
MA1952568529OtherOPTUM/HARVARD PILGRIM/UBH
MA70010000P08073OtherBCBS
MAS300160621Medicaid