MEDICARE: COLLEEN BOKMAN LCSW-C, LICSW, LCSW

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	1041C0700X	Clinical Social Worker	LC200001795	DC
2	1041C0700X	Clinical Social Worker	0904013961	VA
3	1041C0700X	Clinical Social Worker	15862	MD

General Provider Information

NPI Number	:	1407687429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN BOKMAN LCSW-C, LICSW, LCSW

Provider Business Mailing Address
First Line	:	4905 DEL RAY AVE STE 210
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-2559
Country	:	US
Telephone Number	:	301-775-2839
Fax Number	:

Provider Business Practice Location Address
First Line	:	4905 DEL RAY AVE STE 210
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-2559
Country	:	US
Telephone Number	:	301-775-2839
Fax Number	:

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

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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Directions to “ COLLEEN BOKMAN LCSW-C, LICSW, LCSW” Practice Location

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