Provider Demographics
NPI:1821526955
Name:BOHL-FABIAN, NOEL (LCSE)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:BOHL-FABIAN
Suffix:
Gender:F
Credentials:LCSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 W 84TH ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4222
Mailing Address - Country:US
Mailing Address - Phone:347-450-1862
Mailing Address - Fax:
Practice Address - Street 1:275 CENTRAL PARK W APT 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3035
Practice Address - Country:US
Practice Address - Phone:347-450-1862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090025-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1003028549Medicaid