Provider Demographics
NPI:1053642751
Name:BOSLEY, CHRISTINE ANGELA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANGELA
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 50TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-4105
Mailing Address - Country:US
Mailing Address - Phone:916-736-2304
Mailing Address - Fax:
Practice Address - Street 1:1508 F ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-1609
Practice Address - Country:US
Practice Address - Phone:916-444-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 231091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical