Provider Demographics
NPI:1952301442
Name:BOOKMAN, MICHELLE DIANNE (MSW LSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DIANNE
Last Name:BOOKMAN
Suffix:
Gender:F
Credentials:MSW LSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:DIANNE
Other - Last Name:TRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 NORTH 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046
Mailing Address - Country:US
Mailing Address - Phone:717-273-1710
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:6079 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST PETERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17520-1267
Practice Address - Country:US
Practice Address - Phone:717-560-1908
Practice Address - Fax:717-560-4941
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW009110L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA033724Medicare ID - Type Unspecified
S93719Medicare UPIN