Provider Demographics
NPI:1407687429
Name:BOKMAN, COLLEEN (LCSW-C, LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:BOKMAN
Suffix:
Gender:F
Credentials:LCSW-C, LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 DEL RAY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2559
Mailing Address - Country:US
Mailing Address - Phone:301-775-2839
Mailing Address - Fax:
Practice Address - Street 1:4905 DEL RAY AVE STE 210
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2559
Practice Address - Country:US
Practice Address - Phone:301-775-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000017951041C0700X
VA09040139611041C0700X
MD158621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical