=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194754176
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVELYN R BOHM EDD ARNP LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2499 GLADES ROAD
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-395-2133
-----------------------------------------------------
Fax | 561-392-4512
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5132 POINTE EMERALD LANE
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486-1446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-392-4512
-----------------------------------------------------
Fax | 561-392-4512
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW4836
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | ARNP2075482
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------