Provider Demographics
NPI:1164539037
Name:BOVE, DAVID RONALD (LCSWR)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RONALD
Last Name:BOVE
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S KAISERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2330
Mailing Address - Country:US
Mailing Address - Phone:845-551-7355
Mailing Address - Fax:845-457-3017
Practice Address - Street 1:2002 ROUTE 17M
Practice Address - Street 2:SUITE 10
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5235
Practice Address - Country:US
Practice Address - Phone:845-551-7355
Practice Address - Fax:845-457-3017
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0510331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2835545OtherOXFORD PROVIDER#
NY365657OtherMVP HEALTHCARE
NY7340118OtherVALUE OPTIONS PROVIDER#
NY7340118OtherGHI PROVIDER#
NY7340118OtherGHI PROVIDER#