Provider Demographics
NPI:1780784801
Name:BOSCO, DEBRA J (LCSW, CASAC)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:J
Last Name:BOSCO
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6687 PINE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GLENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13343-1816
Mailing Address - Country:US
Mailing Address - Phone:315-376-6276
Mailing Address - Fax:
Practice Address - Street 1:7714 NUMBER THREE RD
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-3521
Practice Address - Country:US
Practice Address - Phone:315-376-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18304101YA0400X
NY072294-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)