Provider Demographics
NPI:1982727582
Name:BOSMA, JENNNIFER A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNNIFER
Middle Name:A
Last Name:BOSMA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9983 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9297
Mailing Address - Country:US
Mailing Address - Phone:724-933-8363
Mailing Address - Fax:
Practice Address - Street 1:9983 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9297
Practice Address - Country:US
Practice Address - Phone:724-933-8363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141691041C0700X
PACW0166171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S45NOtherBLUE CROSS BLUE SHIELD
PA002156853OtherHIGHMARK BLUE SHIELD
TXSW00S45N2Medicaid