Provider Demographics
NPI:1760772123
Name:BOSE, AYON (LMHC)
Entity Type:Individual
Prefix:MR
First Name:AYON
Middle Name:
Last Name:BOSE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:397 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1223
Mailing Address - Country:US
Mailing Address - Phone:508-791-3677
Mailing Address - Fax:
Practice Address - Street 1:45 LYMAN ST STE 11
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-791-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health