Provider Demographics
NPI:1790099000
Name:BOSCOW, DAVID ARTHUR
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ARTHUR
Last Name:BOSCOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 LAVA RIDGE CT STE 140
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2804
Mailing Address - Country:US
Mailing Address - Phone:916-771-3707
Mailing Address - Fax:916-771-3727
Practice Address - Street 1:2281 LAVA RIDGE CT STE 140
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2804
Practice Address - Country:US
Practice Address - Phone:916-771-3707
Practice Address - Fax:916-771-3727
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-B1004231543101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)