Provider Demographics
NPI:1215713722
Name:BOOKHARD - DIMOH, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:BOOKHARD - DIMOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:B
Other - Last Name:DIMOH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHC
Mailing Address - Street 1:11739 125TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2729
Mailing Address - Country:US
Mailing Address - Phone:917-373-1862
Mailing Address - Fax:866-217-5980
Practice Address - Street 1:11739 125TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2729
Practice Address - Country:US
Practice Address - Phone:917-373-1862
Practice Address - Fax:866-217-5980
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health