Provider Demographics
NPI:1023750387
Name:BROGLE, BJORN G (LMSW)
Entity type:Individual
Prefix:
First Name:BJORN
Middle Name:G
Last Name:BROGLE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5119
Mailing Address - Country:US
Mailing Address - Phone:646-317-7505
Mailing Address - Fax:646-317-7525
Practice Address - Street 1:6620 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5119
Practice Address - Country:US
Practice Address - Phone:646-317-7505
Practice Address - Fax:646-317-7525
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050590-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty