CARLY BOSACKER PSY.D.
NPI 1720539554
Psychologist - Clinical Child & Adolescent in New York, NY

Q: What is Carly Bosacker's NPI number?

The NPI number for Carly Bosacker is 1720539554. It was assigned to this individual provider in the NPPES registry on October 17, 2016.

Q: What is Carly Bosacker's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical Child & Adolescent, with taxonomy code 103TC2200X.

Q: Is Carly Bosacker enrolled in Medicare?

No. Carly Bosacker has opted out of Medicare through November 19, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Carly Bosacker was last updated on October 17, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 17, 2016Opted out of Medicare · through Nov 19, 2027

124 W 79TH ST APT 1B, NEW YORK, NY 10024(763) 234-7825 Get Directions Write a Review

NPPES record last updated: October 17, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Carly Bosacker Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CARLY BOSACKER PSY.D. (NPI 1720539554) is an individual clinical child & adolescent provider in New York, New York, licensed in New York (982912738) and active in the NPI registry since October 2016. She has opted out of Medicare through November 19, 2027.

NPPES Registry Identity

NPI1720539554

Entity TypeIndividualFemale

Primary Taxonomy103TC2200X

Provider Legal NameCARLY BOSACKERCredential: PSY.D.

Location Address124 W 79TH ST APT 1BNew York, NY 10024-6488

Mailing Address93 1st Pl, Apt 3fBrooklyn, NY 11231-3497 · (763) 234-7825

Phone(763) 234-7825

Sole ProprietorNo

Enumeration DateOctober 17, 2016

✔ NPI 1720539554 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · Clinical Child & AdolescentBehavioral Health & Social Service Providers

Taxonomy Code103TC2200X

License✔ Licensed in NY · 982912738

Definition

A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents.

124 W 79TH ST APT 1B, New York, NY 10024

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Carly Bosacker Psy.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from November 19, 2025 through November 19, 2027.

Opt-Out Effective DateNovember 19, 2025

Opt-Out In Effect ThroughNovember 19, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

COPE NYC LCSW PLLC

Clinic/Center (Mental Health (Including Community Mental Health Center))