Provider Demographics
NPI:1033704655
Name:BOHLKE O'GARA, BETTE
Entity Type:Individual
Prefix:
First Name:BETTE
Middle Name:
Last Name:BOHLKE O'GARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 MINOT ST # 304
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2039
Mailing Address - Country:US
Mailing Address - Phone:617-288-0956
Mailing Address - Fax:617-288-2042
Practice Address - Street 1:206 MINOT ST # 304
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02122-2039
Practice Address - Country:US
Practice Address - Phone:617-288-0956
Practice Address - Fax:617-288-2042
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1022811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical