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 1:1132 BISHOP ST UNIT 1814
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2895
Mailing Address - Country:US
Mailing Address - Phone:504-644-1912
Mailing Address - Fax:504-644-1912
Practice Address - Street 1:1132 BISHOP ST UNIT 1814
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2895
Practice Address - Country:US
Practice Address - Phone:504-644-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X
LA138451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator