Provider Demographics
NPI:1295400174
Name:BOSCH BATULE, MONICA JOANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:JOANN
Last Name:BOSCH BATULE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10930 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2302
Mailing Address - Country:US
Mailing Address - Phone:305-322-9311
Mailing Address - Fax:
Practice Address - Street 1:3621 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3636
Practice Address - Country:US
Practice Address - Phone:786-534-8366
Practice Address - Fax:786-534-7118
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL186831041C0700X
FLSW18683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical