Provider Demographics
NPI:1013021187
Name:BOHNET, BETH A (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:A
Last Name:BOHNET
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5309
Mailing Address - Country:US
Mailing Address - Phone:207-945-0039
Mailing Address - Fax:
Practice Address - Street 1:51 GROVE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5309
Practice Address - Country:US
Practice Address - Phone:207-945-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME584103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM4684Medicare ID - Type Unspecified