Provider Demographics
NPI:1942537279
Name:BOSCO, IRENE
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:BOSCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 MILL ST STE 224
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06023-1159
Mailing Address - Country:US
Mailing Address - Phone:475-238-8829
Mailing Address - Fax:203-774-1150
Practice Address - Street 1:1224 MILL ST STE 224
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06023-1159
Practice Address - Country:US
Practice Address - Phone:475-238-8829
Practice Address - Fax:203-774-1150
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0069911041C0700X
FLSW 115591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical