Provider Demographics
NPI:1295829273
Name:BOSLEY, CHRISSY M (LCSW QCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISSY
Middle Name:M
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:LCSW QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11147 STATE HWY 18 SUITE #5
Mailing Address - Street 2:SUITE #5
Mailing Address - City:CONNEAUT LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16316
Mailing Address - Country:US
Mailing Address - Phone:814-382-8798
Mailing Address - Fax:
Practice Address - Street 1:11147 STATE HWY 18 SUITE #5
Practice Address - Street 2:SUITE #5
Practice Address - City:CONNEAUT LAKE
Practice Address - State:PA
Practice Address - Zip Code:16316
Practice Address - Country:US
Practice Address - Phone:814-382-8798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW013913101YM0800X
HILCSW45301041C0700X
OHI.12007191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039712Medicare ID - Type Unspecified