Provider Demographics
NPI:1427294206
Name:BOSCH, ISORA C (LCSW)
Entity type:Individual
Prefix:MS
First Name:ISORA
Middle Name:C
Last Name:BOSCH
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 1:7100 BOULEVARD EAST
Mailing Address - Street 2:APT. 5P
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4717
Mailing Address - Country:US
Mailing Address - Phone:201-868-5454
Mailing Address - Fax:
Practice Address - Street 1:3720 76TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6502
Practice Address - Country:US
Practice Address - Phone:718-429-0045
Practice Address - Fax:718-429-0738
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-27
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO55451-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical