Provider Demographics
NPI:1245967025
Name:BOSCO THERAPY LCSW PC
Entity type:Organization
Organization Name:BOSCO THERAPY LCSW PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BASQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-523-9000
Mailing Address - Street 1:777 E TAHQUITZ CANYON WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6797
Mailing Address - Country:US
Mailing Address - Phone:760-523-9000
Mailing Address - Fax:
Practice Address - Street 1:777 E TAHQUITZ CANYON WAY STE 200
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6797
Practice Address - Country:US
Practice Address - Phone:760-523-9000
Practice Address - Fax:760-904-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty