Provider Demographics
NPI:1851546774
Name:BOGLE-AUSTEIN, CHRISTINE JOANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JOANNE
Last Name:BOGLE-AUSTEIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:JOANNE
Other - Last Name:BOGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2508
Mailing Address - Country:US
Mailing Address - Phone:631-608-5028
Mailing Address - Fax:
Practice Address - Street 1:400 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2508
Practice Address - Country:US
Practice Address - Phone:631-608-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044866-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker