MEDICARE: DR. ERICKA G. BOHNEL PSYD

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	103TC0700X	Clinical Psychologist	9191	MA
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1356549554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICKA G. BOHNEL PSYD

Provider Business Mailing Address
First Line	:	44 LONGWOOD AVE UNIT 889
Second Line	:
City	:	HYANNIS PORT
State	:	MA
Zip	:	02647-7039
Country	:	US
Telephone Number	:	612-600-8449
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 LONGWOOD AVE UNIT 889
Second Line	:
City	:	HYANNIS PORT
State	:	MA
Zip	:	02647-7039
Country	:	US
Telephone Number	:	612-600-8449
Fax Number	:

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	03/01/2024

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