Healthcare Provider Details

I. General information

NPI: 1295528396
Provider Name (Legal Business Name): BOSQUE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 CALLE BROCHA
SANTA FE NM
87505-5272
US

IV. Provider business mailing address

2304 CALLE BROCHA
SANTA FE NM
87505-5272
US

V. Phone/Fax

Practice location:
  • Phone: 651-295-3866
  • Fax:
Mailing address:
  • Phone: 651-295-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW ANDRIESCU
Title or Position: OWNER
Credential:
Phone: 651-295-3866