Provider Demographics
NPI:1699709899
Name:BOHAN, NANCY J (LCSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:BOHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3872
Mailing Address - Country:US
Mailing Address - Phone:203-803-5335
Mailing Address - Fax:
Practice Address - Street 1:1 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3872
Practice Address - Country:US
Practice Address - Phone:203-803-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0030031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11241338OtherC.A.Q.H. PROV ID
CT11241338OtherC.A.Q.H. PROV ID