Healthcare Provider Details

I. General information

NPI: 1487506994
Provider Name (Legal Business Name): AUTUMN S BOZZO MSN, PMHNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 WASHINGTONIAN BLVD STE 500
GAITHERSBURG MD
20878-5824
US

IV. Provider business mailing address

6235 CLIFFSIDE TER
FREDERICK MD
21701-5883
US

V. Phone/Fax

Practice location:
  • Phone: 240-262-3697
  • Fax:
Mailing address:
  • Phone: 240-422-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR139201
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: