Provider Demographics
NPI:1932235256
Name:BOGGS, AUDREY E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:E
Last Name:BOGGS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30200 AGOURA RD STE 190
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-5431
Mailing Address - Country:US
Mailing Address - Phone:818-295-2428
Mailing Address - Fax:
Practice Address - Street 1:30200 AGOURA RD STE 190
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-5431
Practice Address - Country:US
Practice Address - Phone:818-295-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22027103TC0700X
CAPSY22027103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent