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General NPI Number Information
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NPI Number | 1053897058
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Entity Type | Individual
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Provider Name | JENNA MICHELLE BOGETTI
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Gender | Female
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 330 W 58TH ST STE 203
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City | NEW YORK
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State | NY
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Zip | 10019-1822
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Country | US
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Telephone | 212-707-8222
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Fax |
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Provider Business Mailing Address
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Address Line | 54 MAYNARD ST
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City | TUCKAHOE
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State | NY
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Zip | 10707-3406
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Country | US
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Telephone | 914-494-4430
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 008884-1
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License Number State | NY
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