Provider Demographics
NPI:1942601398
Name:BOSSARD, BRIANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:BOSSARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2414
Mailing Address - Country:US
Mailing Address - Phone:209-534-0263
Mailing Address - Fax:209-577-3805
Practice Address - Street 1:706 13TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2414
Practice Address - Country:US
Practice Address - Phone:209-534-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA947921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical