Provider Demographics
NPI:1215078613
Name:BOSAK, LORNA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:
Last Name:BOSAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N COUNTRY RD STE F
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1429
Mailing Address - Country:US
Mailing Address - Phone:631-928-4815
Mailing Address - Fax:631-928-4817
Practice Address - Street 1:550 N COUNTRY RD STE F
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1429
Practice Address - Country:US
Practice Address - Phone:631-928-4815
Practice Address - Fax:631-928-4817
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPO0551521041C0700X
NYP0551521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical