Provider Demographics
NPI:1154496586
Name:BOSSIO, JEFFREY MARK (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MARK
Last Name:BOSSIO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1068
Mailing Address - Country:US
Mailing Address - Phone:781-582-0887
Mailing Address - Fax:
Practice Address - Street 1:80 WASHINGTON ST STE C17
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1729
Practice Address - Country:US
Practice Address - Phone:781-347-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1137241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical