Provider Demographics
NPI:1437362753
Name:BOHR, AUDREY EMERY (MSS)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:EMERY
Last Name:BOHR
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 WADSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1134
Mailing Address - Country:US
Mailing Address - Phone:215-242-2198
Mailing Address - Fax:
Practice Address - Street 1:613 WADSWORTH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1134
Practice Address - Country:US
Practice Address - Phone:215-242-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW 002010-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW002010LOtherLICENSE