Healthcare Provider Details

I. General information

NPI: 1750588463
Provider Name (Legal Business Name): MICHAEL EDWARD BOEHM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 33RD ST
BROOKLYN NY
11232-2109
US

IV. Provider business mailing address

189 33RD ST
BROOKLYN NY
11232-2109
US

V. Phone/Fax

Practice location:
  • Phone: 718-757-8381
  • Fax:
Mailing address:
  • Phone: 718-757-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: