Provider Demographics
NPI:1487004453
Name:BOMZER, BATSHEVA RENA (LMSW)
Entity Type:Individual
Prefix:
First Name:BATSHEVA
Middle Name:RENA
Last Name:BOMZER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BATSHEVA
Other - Middle Name:
Other - Last Name:BOMZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:42 EDISON CT APT G
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1927
Mailing Address - Country:US
Mailing Address - Phone:443-547-3923
Mailing Address - Fax:
Practice Address - Street 1:728 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW SQUARE
Practice Address - State:NY
Practice Address - Zip Code:10977-8916
Practice Address - Country:US
Practice Address - Phone:845-354-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094338-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical