Provider Demographics
NPI:1962156364
Name:BOSSO, DANA MONICA
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MONICA
Last Name:BOSSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2305
Mailing Address - Country:US
Mailing Address - Phone:650-343-8401
Mailing Address - Fax:
Practice Address - Street 1:202 E BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2305
Practice Address - Country:US
Practice Address - Phone:650-343-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASUDRC12876101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)