Provider Demographics
NPI:1417479981
Name:BOSCH, MELYNDA J (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELYNDA
Middle Name:J
Last Name:BOSCH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16054 MISTFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:FL
Mailing Address - Zip Code:33920-4678
Mailing Address - Country:US
Mailing Address - Phone:623-866-9808
Mailing Address - Fax:
Practice Address - Street 1:16054 MISTFLOWER DR
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:FL
Practice Address - Zip Code:33920-4678
Practice Address - Country:US
Practice Address - Phone:623-866-9808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-16
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099255031041C0700X
AZLCSW-180351041C0700X
FLSW154441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical