Provider Demographics
NPI:1346286440
Name:BOHON, MARY THERESE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESE
Last Name:BOHON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:THERESE
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:9 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1633
Mailing Address - Country:US
Mailing Address - Phone:207-284-7991
Mailing Address - Fax:207-284-7991
Practice Address - Street 1:9 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1633
Practice Address - Country:US
Practice Address - Phone:207-284-7991
Practice Address - Fax:207-284-7991
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC44461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical