Individual
LISA ELLEN BOGRAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
2936 DOMINGO AVE, BERKELEY, CA 94705-2443
(415) 820-3920
Mailing address
5928 ASCOT DR, OAKLAND, CA 94611-2705
(510) 530-3690
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MFC39608
CA
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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