Provider Demographics
NPI:1982621702
Name:BOSQUET ENLOW, MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:BOSQUET ENLOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 AUTUMN ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5317
Mailing Address - Country:US
Mailing Address - Phone:617-919-4680
Mailing Address - Fax:617-730-0759
Practice Address - Street 1:21 AUTUMN ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5317
Practice Address - Country:US
Practice Address - Phone:617-919-4680
Practice Address - Fax:617-730-0759
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist