Provider Demographics
NPI:1093836926
Name:BOSLEY, BRYNA ANGELIQUE (LMSW)
Entity type:Individual
Prefix:MS
First Name:BRYNA
Middle Name:ANGELIQUE
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 HERCULES AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-3463
Mailing Address - Country:US
Mailing Address - Phone:734-858-0278
Mailing Address - Fax:
Practice Address - Street 1:17940 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4444
Practice Address - Country:US
Practice Address - Phone:734-858-0280
Practice Address - Fax:313-388-0472
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010879761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical