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General NPI Number Information
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NPI Number | 1013609833
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Entity Type | Individual
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Provider Name | GISELE ROSINE BOGOTO LICSW
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Gender | Female
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 1039 BLADENSBURG RD NE
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City | WASHINGTON
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State | DC
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Zip | 20002-2922
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Country | US
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Telephone | 202-507-8139
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Fax |
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Provider Business Mailing Address
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Address Line | 11700 OLD COLUMBIA PIKE APT 318
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City | SILVER SPRING
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State | MD
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Zip | 20904-2552
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Country | US
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Telephone | 443-653-6359
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC200003280
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License Number State | DC
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