Provider Demographics
NPI:1750448510
Name:BOS, WENDELINA AMTOINETTE (PSYD)
Entity Type:Individual
Prefix:MS
First Name:WENDELINA
Middle Name:AMTOINETTE
Last Name:BOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08553-0321
Mailing Address - Country:US
Mailing Address - Phone:609-504-5245
Mailing Address - Fax:
Practice Address - Street 1:201 WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08553-0321
Practice Address - Country:US
Practice Address - Phone:609-504-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00387200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist