Provider Demographics
NPI:1326575119
Name:BOSWELL, WILLIAM (LICDC-CS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1041
Mailing Address - Country:US
Mailing Address - Phone:330-615-7355
Mailing Address - Fax:734-758-0784
Practice Address - Street 1:718 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1041
Practice Address - Country:US
Practice Address - Phone:330-615-7355
Practice Address - Fax:734-758-0784
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCS-R.82785101YA0400X
OHCS.00000375101YA0400X
OHLICDC.82785101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0410735Medicaid