| Doctor Name: | TRACY L BOSIS |
| NPI Number: | 1568664696 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | CW015456 |
| Business Practice Address: | 1417 Oregon Rd Leola, PA - 175409754 |
| Business Phone Number: | 7176566580 |
| Business Fax Number: | 7176563056 |
| Mailing Address: | 1417 Oregon Rd, LEOLA |
| State: | PA |
| Postal Code: | 175409754 |
| Phone Number: | 7176566580 |
| Fax Number: | 7176563056 |
| NPI Enumeration Date: | 06/01/2007 |
| NPI Last Update Date: | 01/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | CW015456 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |