Healthcare Provider Details

I. General information

NPI: 1205883493
Provider Name (Legal Business Name): WILHELMINA F BOSMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SE FEDERAL HWY SUITE 218
STUART FL
34994-3840
US

IV. Provider business mailing address

266 SW HOMELAND RD
PORT SAINT LUCIE FL
34953-6205
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-0541
  • Fax: 772-220-9894
Mailing address:
  • Phone: 772-336-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: