Provider Demographics
NPI:1740583434
Name:BOGDANOVA, YELENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:BOGDANOVA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:YELENA
Other - Middle Name:BOGDANOVA
Other - Last Name:SOKOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:PSYCHOLOGY RESEARCH (151-A)
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:PSYCHOLOGY RESEARCH (151-A)
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01193103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist