Provider Demographics
NPI:1790869378
Name:BOSTON, GLORIA ANN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:ANN
Last Name:BOSTON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 COHASETT ROAD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927
Mailing Address - Country:US
Mailing Address - Phone:530-879-5017
Mailing Address - Fax:530-899-0581
Practice Address - Street 1:280 COHASETT ROAD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95927
Practice Address - Country:US
Practice Address - Phone:530-879-5017
Practice Address - Fax:530-899-0581
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS138081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical