Basic Information
| Provider Information | |||||||||
| NPI: | 1881987378 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOSTWICK | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | GILLARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | LISW, LCDCIII, SAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20800 CENTER RIDGE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FAIRVIEW PARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403334949 | ||||||||
| FaxNumber: | 4403335044 | ||||||||
| Practice Location | |||||||||
| Address1: | 20800 WESTGATE PROFESSIONAL CENTER | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FAIRVIEW PARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403334949 | ||||||||
| FaxNumber: | 4403335044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2011 | ||||||||
| LastUpdateDate: | 05/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | I110097 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.