Individual
MRS. TARA MABEL BRANNON BOGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
400 BALD HILL RD, SUITE 517, WARWICK, RI 02886-1617
(401) 732-1500
Mailing address
1075 SMITH ST, PROVIDENCE, RI 02908-2700
(401) 369-9224
(401) 369-9275
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
PS01420
RI
103TC0700X
Clinical Psychologist
PSY25755
CA
Other
Enumeration date
11/22/2006
Last updated
07/18/2019
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