Provider Demographics
NPI:1831258680
Name:BOGLIO MARTINEZ, VANESSA I (PSY D)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:I
Last Name:BOGLIO MARTINEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1019 AVE LUIS VIGOREAUX
Mailing Address - Street 2:CONDOMINIO DORAL PLAZA I APT. E-2
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2400
Mailing Address - Country:US
Mailing Address - Phone:787-236-8733
Mailing Address - Fax:
Practice Address - Street 1:1607 AVE PONCE DE LEON
Practice Address - Street 2:EDIFICION COBIAN'S PLAZA SUITE 301
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-1820
Practice Address - Country:US
Practice Address - Phone:787-236-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2629103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical