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General NPI Number Information
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NPI Number | 1629317235
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Entity Type | Individual
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Provider Name | AMY BOHM LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 475 Bement Avenue
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City | Staten Island
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State | New York
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Zip | 10310
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Country | US
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Telephone | 917-414-4465
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Fax |
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Provider Business Mailing Address
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Address Line | 475 Bement Avenue
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City | Staten Island
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State | New York
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Zip | 10310
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Country | US
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Telephone | 917-414-4465
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical
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License Number | 081020
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License Number State | NY
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