Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 074758 | NY |
NPI | 1003054834 |
---|---|
Provider Name | Mr. Orlando Bosch |
First Address | Bronx, NY 10456-3402 |
Second Address | Bronx, NY 10456-3402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2009 |
Last Update Date | 02/02/2009 |