Provider Demographics
NPI:1588977805
Name:BOMAS, KRISTEN (MS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BOMAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 SE 8TH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5623
Mailing Address - Country:US
Mailing Address - Phone:954-725-7200
Mailing Address - Fax:954-725-7244
Practice Address - Street 1:810 SE 8TH AVE
Practice Address - Street 2:STE A
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5623
Practice Address - Country:US
Practice Address - Phone:954-725-7200
Practice Address - Fax:954-725-7244
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5083101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health