MEDICARE: SHELLEY E. BOGGAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW8189	FL

General Provider Information

NPI Number	:	1093992091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY E. BOGGAN LCSW

Provider Business Mailing Address
First Line	:	1300 BRUCE B DOWNS BLVD
Second Line	:	SOCIAL WORK SERVICES
City	:	TAMPA
State	:	FL
Zip	:	33612-9217
Country	:	US
Telephone Number	:	813-972-2000
Fax Number	:	813-903-2429

Provider Business Practice Location Address
First Line	:	1300 BRUCE B DOWNS BLVD
Second Line	:	SOCIAL WORK SERVICES
City	:	TAMPA
State	:	FL
Zip	:	33612-9217
Country	:	US
Telephone Number	:	813-972-2000
Fax Number	:	813-903-2429

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	01/22/2008

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