Provider Demographics
NPI:1780083303
Name:BOAMAH, IRENE (CSW)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:BOAMAH
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 ASHLEY CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5801
Mailing Address - Country:US
Mailing Address - Phone:270-320-1662
Mailing Address - Fax:270-846-4887
Practice Address - Street 1:489 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7407
Practice Address - Country:US
Practice Address - Phone:270-320-1662
Practice Address - Fax:270-846-4887
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical