Provider Demographics
NPI:1639730096
Name:JALIU, BOGDANA (PSYD)
Entity type:Individual
Prefix:DR
First Name:BOGDANA
Middle Name:
Last Name:JALIU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BOGDANA
Other - Middle Name:
Other - Last Name:ANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2309 OLD BAINBRIDGE RD APT 1002B
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3850
Mailing Address - Country:US
Mailing Address - Phone:678-900-7149
Mailing Address - Fax:
Practice Address - Street 1:267 JOHN KNOX RD STE 105
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6692
Practice Address - Country:US
Practice Address - Phone:678-900-7149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10457103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist