Provider Demographics
NPI:1528719721
Name:BOSER, KARISSA K (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:KARISSA
Middle Name:K
Last Name:BOSER
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 SW 47TH ST LOT E27
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2288
Mailing Address - Country:US
Mailing Address - Phone:352-888-4928
Mailing Address - Fax:877-875-4912
Practice Address - Street 1:500 E UNIVERSITY AVE STE C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3458
Practice Address - Country:US
Practice Address - Phone:352-888-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health