Provider Demographics
NPI:1134770027
Name:BOSLEY, ALICIA A (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:A
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BEACH 26TH ST APT 615
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2238
Mailing Address - Country:US
Mailing Address - Phone:970-219-7346
Mailing Address - Fax:
Practice Address - Street 1:120 BEACH 26TH ST APT 615
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2238
Practice Address - Country:US
Practice Address - Phone:970-219-7346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001581-01106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist