Provider Demographics
NPI:1760530398
Name:MAYFIELD-BOZA, THERESA PRISCILLA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:PRISCILLA
Last Name:MAYFIELD-BOZA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 VALENTINE LN APT 3L
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-3437
Mailing Address - Country:US
Mailing Address - Phone:914-963-5567
Mailing Address - Fax:
Practice Address - Street 1:145 VALENTINE LN APT 3L
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3437
Practice Address - Country:US
Practice Address - Phone:914-963-5567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR019608-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical