Provider Demographics
NPI:1205883493
Name:BOSMAN, WILHELMINA F (LCSW)
Entity type:Individual
Prefix:
First Name:WILHELMINA
Middle Name:F
Last Name:BOSMAN
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 1:266 SW HOMELAND RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6205
Mailing Address - Country:US
Mailing Address - Phone:772-336-4435
Mailing Address - Fax:
Practice Address - Street 1:1111 SE FEDERAL HWY
Practice Address - Street 2:SUITE 218
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3840
Practice Address - Country:US
Practice Address - Phone:772-283-0541
Practice Address - Fax:772-220-9894
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW73611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7031ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER