Provider Demographics
NPI:1265552236
Name:BOGEN, PAMELA JUDY (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JUDY
Last Name:BOGEN
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 1:3885 GOLDEN POND DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-7740
Mailing Address - Country:US
Mailing Address - Phone:805-484-4522
Mailing Address - Fax:
Practice Address - Street 1:800 S VICTORIA AVE # L4615
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93009-2103
Practice Address - Country:US
Practice Address - Phone:805-504-7358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW124711041C0700X
CA254191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical