Provider Demographics
NPI:1851636013
Name:BOHLIG, BETHANY C (LMSW)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:C
Last Name:BOHLIG
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 1:60 E 42ND ST
Mailing Address - Street 2:SUITE 2401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10165-0006
Mailing Address - Country:US
Mailing Address - Phone:212-557-8660
Mailing Address - Fax:212-692-9350
Practice Address - Street 1:60 E 42ND ST
Practice Address - Street 2:SUITE 2401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10165-0006
Practice Address - Country:US
Practice Address - Phone:212-557-8660
Practice Address - Fax:212-692-9350
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080298-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker