MEDICARE: SUSAN JOAN BOSETTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225C00000X	Rehabilitation Counselor	00110522	PA
2	101YP2500X	Professional Counselor	PC005984	PA

General Provider Information

NPI Number	:	1689338618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN JOAN BOSETTI

Provider Business Mailing Address
First Line	:	817 JEFFERSON AVE
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-3822
Country	:	US
Telephone Number	:	724-249-2517
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 JEFFERSON AVE
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-3822
Country	:	US
Telephone Number	:	412-680-5689
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	10/26/2021

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Directions to “ SUSAN JOAN BOSETTI ” Practice Location

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