Provider Demographics
NPI:1194220905
Name:BOSCH, ENRIQUE
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:BOSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 SW 18TH ST
Mailing Address - Street 2:APT 301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3240
Mailing Address - Country:US
Mailing Address - Phone:561-255-6529
Mailing Address - Fax:
Practice Address - Street 1:2965 SW 18TH ST
Practice Address - Street 2:APT 301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3240
Practice Address - Country:US
Practice Address - Phone:561-255-6529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM102164104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker