MEDICARE: MR. JOSEPH A BOVA

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

General Provider Information

NPI Number	:	1720668890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH A BOVA

Provider Business Mailing Address
First Line	:	4846 N PAULINA ST APT 1E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4179
Country	:	US
Telephone Number	:	310-710-4950
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5413
Country	:	US
Telephone Number	:	773-888-1681
Fax Number	:

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

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	04/12/2021

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