MEDICARE: MRS. MICHELLE DIANNE BOOKMAN MSW LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	SW009110L	PA

General Provider Information

NPI Number	:	1952301442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE DIANNE BOOKMAN MSW LSW

Provider Business Mailing Address
First Line	:	200 NORTH 7TH ST
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17046
Country	:	US
Telephone Number	:	717-273-1710
Fax Number	:	717-273-1416

Provider Business Practice Location Address
First Line	:	6079 MAIN ST
Second Line	:
City	:	EAST PETERSBURG
State	:	PA
Zip	:	17520-1267
Country	:	US
Telephone Number	:	717-560-1908
Fax Number	:	717-560-4941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/08/2007

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