Provider Demographics
NPI:1720224124
Name:BOSCO, LARRY JAMES (ATR-BC, LMHC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:JAMES
Last Name:BOSCO
Suffix:
Gender:M
Credentials:ATR-BC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-1653
Mailing Address - Country:US
Mailing Address - Phone:781-834-8640
Mailing Address - Fax:
Practice Address - Street 1:182 SUMMER ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-1653
Practice Address - Country:US
Practice Address - Phone:781-834-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health