Provider Demographics
NPI:1558104562
Name:BOGART, ELIYAHU (LMHC)
Entity type:Individual
Prefix:
First Name:ELIYAHU
Middle Name:
Last Name:BOGART
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 NORTON PKWY
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2830
Mailing Address - Country:US
Mailing Address - Phone:203-494-3766
Mailing Address - Fax:
Practice Address - Street 1:443 NORTON PKWY
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2830
Practice Address - Country:US
Practice Address - Phone:203-494-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CT006957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health