Provider Demographics
NPI:1558520718
Name:BOHY, KIMBERLY LOEWEN (PSYD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOEWEN
Last Name:BOHY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 OLD TOWN AVE
Mailing Address - Street 2:SUITE A208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2930
Mailing Address - Country:US
Mailing Address - Phone:619-794-4229
Mailing Address - Fax:619-550-1468
Practice Address - Street 1:3990 OLD TOWN AVE
Practice Address - Street 2:SUITE A208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2930
Practice Address - Country:US
Practice Address - Phone:619-794-4229
Practice Address - Fax:619-550-1468
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23978103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical