Provider Demographics
NPI:1194369702
Name:BOZE, TROY E (CRPA, MHFA)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:E
Last Name:BOZE
Suffix:
Gender:M
Credentials:CRPA, MHFA
Other - Prefix:MR
Other - First Name:TROY
Other - Middle Name:E
Other - Last Name:BOZE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRPA, MHFA
Mailing Address - Street 1:25 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6935
Mailing Address - Country:US
Mailing Address - Phone:718-300-4108
Mailing Address - Fax:
Practice Address - Street 1:25 AVENUE D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-6935
Practice Address - Country:US
Practice Address - Phone:718-300-4108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCRPA-3221101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)