Provider Demographics
NPI:1497810154
Name:BOSSERT, PATRICIA-ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA-ANN
Middle Name:
Last Name:BOSSERT
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 1:1274 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-1469
Mailing Address - Country:US
Mailing Address - Phone:408-380-1215
Mailing Address - Fax:408-441-0924
Practice Address - Street 1:3190 S BASCOM AVE
Practice Address - Street 2:STE. 180
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2569
Practice Address - Country:US
Practice Address - Phone:408-380-1215
Practice Address - Fax:408-441-0924
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 170911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical