Healthcare Provider Details

I. General information

NPI: 1386601573
Provider Name (Legal Business Name): DONNA CLAIRE VOGELER-BOUTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: DONNA CLAIRE VOGELER LCSW

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 3622, RAY BARRACKS
APO AE
09074
US

IV. Provider business mailing address

CMR 453, P. O. BOX 2194
APO AE
09074
US

V. Phone/Fax

Practice location:
  • Phone: 06031813204
  • Fax: 06031813161
Mailing address:
  • Phone: 06031813204
  • Fax: 06031813161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4245-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: