Provider Demographics
NPI:1952772881
Name:BOSSICK, NATHANIEL R (LCSW)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:R
Last Name:BOSSICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4586A E EHA WAY
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:504-644-1912
Mailing Address - Fax:504-644-1912
Practice Address - Street 1:4586A E EHA WAY
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:504-644-1912
Practice Address - Fax:504-644-1912
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101Y00000X
HI50111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor