Provider Demographics
NPI:1518362284
Name:BOHENKO, ADELE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ADELE
Middle Name:
Last Name:BOHENKO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:ADELE
Other - Middle Name:
Other - Last Name:INIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8624 DOLLHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-4838
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8624 DOLLHOUSE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-4838
Practice Address - Country:US
Practice Address - Phone:978-413-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1183171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical