MEDICARE: CHARLES HENRY BOOKMAN CPRS, CDCA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.194933	OH
2	171M00000X	Case Manager/Care Coordinator
3	172V00000X	Community Health Worker
4	175T00000X	Peer Specialist	APS.004899	OH

General Provider Information

NPI Number	:	1417713306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES HENRY BOOKMAN CPRS, CDCA

Provider Business Mailing Address
First Line	:	PO BOX 243
Second Line	:
City	:	SUGAR GROVE
State	:	OH
Zip	:	43155-0243
Country	:	US
Telephone Number	:	614-404-6008
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 E MAIN ST
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-3808
Country	:	US
Telephone Number	:	614-404-6008
Fax Number	:

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

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	01/27/2026

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