Provider Demographics
NPI:1902031958
Name:BOGLE, ODETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:ODETTE
Middle Name:
Last Name:BOGLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 OLIVER WAY
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1987
Mailing Address - Country:US
Mailing Address - Phone:860-977-6248
Mailing Address - Fax:
Practice Address - Street 1:128 HOMESTEAD AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-2339
Practice Address - Country:US
Practice Address - Phone:860-944-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker