| Bosque Therapy LLC | |
|
2304 Calle Brocha Santa Fe NM 87505-5272 | |
| (651) 295-3866 | |
| Not Available |
| Full Name | Bosque Therapy LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 2304 Calle Brocha, Santa Fe, New Mexico |
| Authorized Official Name and Position | Matthew Andriescu (OWNER) |
| Authorized Official Contact | 6512953866 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bosque Therapy LLC 2304 Calle Brocha Santa Fe NM 87505-5272 Ph: (651) 295-3866 | Bosque Therapy LLC 2304 Calle Brocha Santa Fe NM 87505-5272 Ph: (651) 295-3866 |
| NPI Number | 1295528396 |
|---|---|
| Provider Enumeration Date | 05/22/2025 |
| Last Update Date | 05/22/2025 |
| Certification Date | 05/22/2025 |
| Medicare PECOS PAC ID | 9537662622 |
|---|---|
| Medicare Enrollment ID | O20250913000493 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295528396 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | () | Primary |
| Provider Name | Matthew R Andriescu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427787431 PECOS PAC ID: 7315462942 Enrollment ID: I20250416001916 |
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