Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 073341-1 | NC |
NPI | 1003031519 |
---|---|
Provider Name | Michelle Louise Bosco |
First Address | Staten Island, NY 10314-4912 |
Second Address | Staten Island, NY 10301-2507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 22/04/2010 |