Healthcare Provider Details

I. General information

NPI: 1699691576
Provider Name (Legal Business Name): STEPHEN CHRISTOPHER BOSCO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 BOND ST APT 513
BROOKLYN NY
11201-8811
US

IV. Provider business mailing address

33 BOND ST APT 513
BROOKLYN NY
11201-8811
US

V. Phone/Fax

Practice location:
  • Phone: 860-818-5588
  • Fax:
Mailing address:
  • Phone: 860-818-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number028279
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: