Tara Mabel Brannon Bogs, Ph.D.
Psychologist, Clinical in Warwick, RI. Individual provider (NPI-1).
NPI number1043385081
StatusActive
Last updated in NPPESJul 18, 2019
Details
- NPI
- 1043385081
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Tara Mabel Brannon Bogs
- Credential
- Ph.D.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 22, 2006
- Last updated
- Jul 18, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | PS01420 | RI | Yes |
| 103TC0700X | Psychologist, Clinical | PSY25755 | CA | |
| 101YM0800X | Counselor, Mental Health | – | – |
Practice location
400 Bald Hill RdSuite 517
Warwick, RI 02886-1617
Phone 401-732-1500
Mailing address
1075 Smith StProvidence, RI 02908-2700
Phone 401-369-9224 · Fax 401-369-9275
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