Provider Demographics
NPI:1831278696
Name:BOLOGH, LAURA BOEKMAN (PHD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BOEKMAN
Last Name:BOLOGH
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 1:6 PERTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-3519
Mailing Address - Country:US
Mailing Address - Phone:914-632-4488
Mailing Address - Fax:
Practice Address - Street 1:45 POPHAM RD
Practice Address - Street 2:1H
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4252
Practice Address - Country:US
Practice Address - Phone:914-725-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014452103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical