Basic Information
| Provider Information | |||||||||
| NPI: | 1669118352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOSCARINO | ||||||||
| FirstName: | HALEY | ||||||||
| MiddleName: | LINDSEY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2351 CARDINAL LN | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921233743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585732227 | ||||||||
| FaxNumber: | 8584962113 | ||||||||
| Practice Location | |||||||||
| Address1: | 2351 CARDINAL LN | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921233743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585732227 | ||||||||
| FaxNumber: | 8584962113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2022 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.