Provider Demographics
NPI:1679385751
Name:BOSCO, ELISABETH ANN (LCSW)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ANN
Last Name:BOSCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 LOVELY ST
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1168
Mailing Address - Country:US
Mailing Address - Phone:860-983-6487
Mailing Address - Fax:
Practice Address - Street 1:202 LOVELY ST
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1168
Practice Address - Country:US
Practice Address - Phone:860-983-6487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5139104100000X
CT015469104100000X
CT154691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker