Healthcare Provider Details

I. General information

NPI: 1861474959
Provider Name (Legal Business Name): MARGARET LILLIAN BOST L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PEGGY KLOTH

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEERHAVEN RD
MAHWAH NJ
07430-2718
US

IV. Provider business mailing address

121 DEERHAVEN RD
MAHWAH NJ
07430-2718
US

V. Phone/Fax

Practice location:
  • Phone: 201-785-0604
  • Fax: 201-785-0604
Mailing address:
  • Phone: 201-785-0604
  • Fax: 201-785-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC03685
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: