Provider Demographics
NPI:1720153240
Name:BOGER, PATRICIA ANN (PHD)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:BOGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 KINGSLEY AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4412
Mailing Address - Country:US
Mailing Address - Phone:904-264-0600
Mailing Address - Fax:904-264-8972
Practice Address - Street 1:1732 KINGSLEY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4412
Practice Address - Country:US
Practice Address - Phone:904-264-0600
Practice Address - Fax:904-264-8972
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3337103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75572OtherBLUE CROSS BLUE SHIELD
FL75572Medicare ID - Type Unspecified