Provider Demographics
NPI:1427394089
Name:BOOKMAN, JEREMY SCOTT (PHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:SCOTT
Last Name:BOOKMAN
Suffix:
Gender:M
Credentials:PHNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:35 MARKET STREET
Mailing Address - Street 2:BRIDGEWELL COUNSELING SERVICES
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852
Mailing Address - Country:US
Mailing Address - Phone:978-459-0389
Mailing Address - Fax:978-459-7642
Practice Address - Street 1:35 MARKET STREET
Practice Address - Street 2:BRIDGEWELL COUNSELING SERVICES
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-459-0389
Practice Address - Fax:978-459-7642
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN253818363LP0808X
MA253818163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health