Provider Demographics
NPI:1790705689
Name:BOGORAD, BARBARA ELLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ELLEN
Last Name:BOGORAD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8707 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-6004
Mailing Address - Country:US
Mailing Address - Phone:714-914-0409
Mailing Address - Fax:
Practice Address - Street 1:18600 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:714-914-0409
Practice Address - Fax:714-827-9497
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19154103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01064891Medicaid
CA11584463OtherCAQH
CA11584463OtherCAQH