Active NPI
Mattie Rose Bogoslavsky, PHD
- Psychologist
- Gainesville, FL
National Provider Identifier
1861172462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY11931
- Practice address
- 4850 SW 91St Ter
Gainesville, FL 32608-6038 - Phone
- (352) 474-8882
- NPI assigned
- Jul 19, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY11931 | FL | Primary |
Addresses
Primary practice location
4850 SW 91St Ter
Gainesville, FL 32608-6038
Mailing address
7977 SW 77TH Ave
Gainesville, FL 32608-9446
Phone (501) 766-4795
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY11931 | FL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689724800000",
"number": "1861172462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7977 SW 77TH AVE",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326089446",
"telephone_number": "501-766-4795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4850 SW 91ST TER",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326086038",
"telephone_number": "352-474-8882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGOSLAVSKY",
"first_name": "MATTIE",
"middle_name": "ROSE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-19",
"last_updated": "2023-07-19",
"certification_date": "2023-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY11931",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.