Provider Demographics
NPI:1689997686
Name:BOHEN, COURTNEY L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:L
Last Name:BOHEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-0736
Mailing Address - Country:US
Mailing Address - Phone:802-356-1478
Mailing Address - Fax:
Practice Address - Street 1:516 MILL RD
Practice Address - Street 2:OFFICE 3A
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-9589
Practice Address - Country:US
Practice Address - Phone:802-356-1478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8900564701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical