Provider Demographics
NPI:1215071667
Name:BOHN, MARTHA B (LCSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:B
Last Name:BOHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6462 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3809
Mailing Address - Country:US
Mailing Address - Phone:941-350-9814
Mailing Address - Fax:941-924-8446
Practice Address - Street 1:6462 BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3809
Practice Address - Country:US
Practice Address - Phone:941-350-9814
Practice Address - Fax:941-924-8446
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW73941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical