MEDICARE: GEORGETTA BOSCO LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	7112	FL

General Provider Information

NPI Number	:	1104907542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGETTA BOSCO LMHC

Provider Business Mailing Address
First Line	:	3910 NORTHDALE BLVD STE 208
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1800
Country	:	US
Telephone Number	:	813-964-5792
Fax Number	:	813-961-5919

Provider Business Practice Location Address
First Line	:	3910 NORTHDALE BLVD STE 208
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1800
Country	:	US
Telephone Number	:	813-964-5792
Fax Number	:	813-961-5919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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