Provider Demographics
NPI:1588432876
Name:EHANIRE, BOMA FABIA (LMSW)
Entity type:Individual
Prefix:
First Name:BOMA
Middle Name:FABIA
Last Name:EHANIRE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 STRAW HAT RD APT 3A
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-7218
Mailing Address - Country:US
Mailing Address - Phone:410-802-8780
Mailing Address - Fax:
Practice Address - Street 1:5010 REGENCY PL STE 203
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3088
Practice Address - Country:US
Practice Address - Phone:240-427-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29721104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker