Healthcare Provider Details

I. General information

NPI: 1003086489
Provider Name (Legal Business Name): DARYL D BOZONE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13220 SCHARBER RD
DADE CITY FL
33525-8008
US

IV. Provider business mailing address

13220 SCHARBER RD
DADE CITY FL
33525-8008
US

V. Phone/Fax

Practice location:
  • Phone: 352-588-5135
  • Fax: 352-588-5135
Mailing address:
  • Phone: 352-588-5135
  • Fax: 352-588-5135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8851
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: