Provider Demographics
NPI:1366550840
Name:BOHLMAN, RUTH GAYLE (LCSWC)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:GAYLE
Last Name:BOHLMAN
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:
Other - Last Name:BOHLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWC
Mailing Address - Street 1:602 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5503
Mailing Address - Country:US
Mailing Address - Phone:410-583-7443
Mailing Address - Fax:410-583-0711
Practice Address - Street 1:600 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5503
Practice Address - Country:US
Practice Address - Phone:410-583-7443
Practice Address - Fax:410-583-0711
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD41113401OtherBCBS
MDKM48JL87Medicare ID - Type Unspecified
MD1689897928Medicare PIN