Provider Demographics
NPI:1992102982
Name:CURRENT-BOMER, ANDREA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:CURRENT-BOMER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 BRIM RD STE 3
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9800
Mailing Address - Country:US
Mailing Address - Phone:419-292-5382
Mailing Address - Fax:419-292-5384
Practice Address - Street 1:1302 BRIM RD STE 3
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9800
Practice Address - Country:US
Practice Address - Phone:419-292-5382
Practice Address - Fax:419-292-5384
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042589A103TH0100X
OH6966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service