Provider Demographics
NPI:1003953225
Name:BOHN, CAROLE RUTH (EDD)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:RUTH
Last Name:BOHN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BIGELOW AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-3308
Mailing Address - Country:US
Mailing Address - Phone:781-369-4050
Mailing Address - Fax:617-353-5539
Practice Address - Street 1:185 BAY STATE RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1506
Practice Address - Country:US
Practice Address - Phone:617-353-3047
Practice Address - Fax:617-353-5539
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional