Provider Demographics
NPI:1902379043
Name:BOJANOWSKA, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BOJANOWSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SE G CT
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6006
Mailing Address - Country:US
Mailing Address - Phone:479-255-2961
Mailing Address - Fax:479-255-4757
Practice Address - Street 1:106 SE G CT
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6006
Practice Address - Country:US
Practice Address - Phone:479-255-2961
Practice Address - Fax:479-255-4757
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2349101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA