Provider Demographics
NPI:1679271399
Name:BOGNER, RACHEL SARAH (LCSW)
Entity type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:SARAH
Last Name:BOGNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4727 W 147TH ST UNIT 228
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1309
Mailing Address - Country:US
Mailing Address - Phone:310-658-3459
Mailing Address - Fax:
Practice Address - Street 1:2200 PACIFIC COAST HWY STE 102
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2700
Practice Address - Country:US
Practice Address - Phone:310-946-7660
Practice Address - Fax:844-805-0886
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1125741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical