Provider Demographics
NPI:1891171278
Name:BOEHMER, BRANDIE JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:JEAN
Last Name:BOEHMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRANDIE
Other - Middle Name:JEAN
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:8917 SW 50TH TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6164
Mailing Address - Country:US
Mailing Address - Phone:507-236-9569
Mailing Address - Fax:833-959-1669
Practice Address - Street 1:8917 SW 50TH TER
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6164
Practice Address - Country:US
Practice Address - Phone:507-236-9569
Practice Address - Fax:833-959-1669
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL226161041C0700X
IA1119751041C0700X
MN177861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical