Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC000026 | PA |
NPI | 1003838863 |
---|---|
Provider Name | Richard Bogert |
First Address | Bethlehem, PA 18017-2344 |
Second Address | Allentown, PA 18104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |