Provider Demographics
NPI:1831761899
Name:BOSQUE, TANYA VICTORIA (LCSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:VICTORIA
Last Name:BOSQUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:VICTORIA
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 713052
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92072-3052
Mailing Address - Country:US
Mailing Address - Phone:562-822-3403
Mailing Address - Fax:
Practice Address - Street 1:2400 E 4TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2026
Practice Address - Country:US
Practice Address - Phone:619-470-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA878001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty