Provider Demographics
NPI:1407633019
Name:BOSSE, ROBIN JOY
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:JOY
Last Name:BOSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7459 W LONE CACTUS DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9519
Mailing Address - Country:US
Mailing Address - Phone:602-451-0832
Mailing Address - Fax:
Practice Address - Street 1:21448 N 75TH AVE STE 6
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5978
Practice Address - Country:US
Practice Address - Phone:602-451-0832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional