Provider Demographics
NPI:1467540195
Name:BOMAN, JUDIE LORRAINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDIE
Middle Name:LORRAINE
Last Name:BOMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11809 SOUTHWICK CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1082
Mailing Address - Country:US
Mailing Address - Phone:415-721-9908
Mailing Address - Fax:
Practice Address - Street 1:2425 FILLMORE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1873
Practice Address - Country:US
Practice Address - Phone:415-721-9908
Practice Address - Fax:925-828-3341
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS194241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10942982OtherCAQH GEOACCESS
CAZZZ27243ZMedicare ID - Type UnspecifiedMEDICARES PROVIDER NUMBER