Provider Demographics
NPI:1548459795
Name:BOGGESS, MELINA R (LCSW)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:R
Last Name:BOGGESS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 78TH ST
Mailing Address - Street 2:APT. 4B
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2571
Mailing Address - Country:US
Mailing Address - Phone:917-304-0710
Mailing Address - Fax:
Practice Address - Street 1:3415 77TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-2333
Practice Address - Country:US
Practice Address - Phone:917-304-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075579104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker