MEDICARE: JESSICA ANN BOVO LCSW

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	1041C0700X	Clinical Social Worker	096723	NY

General Provider Information

NPI Number	:	1740895358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANN BOVO LCSW

Provider Business Mailing Address
First Line	:	98120 QUEENS BLVD STE 1C
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-4414
Country	:	US
Telephone Number	:	347-244-3182
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3609
Country	:	US
Telephone Number	:	347-244-3182
Fax Number	:

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

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	04/07/2024

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