Provider Demographics
NPI:1770546137
Name:BOHM, STEFANI LYN (LSW)
Entity type:Individual
Prefix:MRS
First Name:STEFANI
Middle Name:LYN
Last Name:BOHM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3404
Mailing Address - Country:US
Mailing Address - Phone:215-793-4546
Mailing Address - Fax:215-793-9007
Practice Address - Street 1:1489 BALTIMORE PIKE
Practice Address - Street 2:SUITE 250
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3958
Practice Address - Country:US
Practice Address - Phone:610-544-2110
Practice Address - Fax:610-604-9510
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW011564L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical