Provider Demographics
NPI:1417165325
Name:BOSSERT, GEORGE TOD W (PHD CLINICAL PSYCHOL)
Entity Type:Individual
Prefix:DR
First Name:GEORGE TOD
Middle Name:W
Last Name:BOSSERT
Suffix:
Gender:M
Credentials:PHD CLINICAL PSYCHOL
Other - Prefix:DR
Other - First Name:TOD
Other - Middle Name:W
Other - Last Name:BOSSERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:784 US HIGHWAY 1
Mailing Address - Street 2:SUITE 20
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408
Mailing Address - Country:US
Mailing Address - Phone:561-627-2220
Mailing Address - Fax:561-627-7017
Practice Address - Street 1:1850 FOREST HILL BOULEVARD
Practice Address - Street 2:SUITE 209
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406
Practice Address - Country:US
Practice Address - Phone:561-968-6003
Practice Address - Fax:561-627-7017
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
74404AMedicare ID - Type Unspecified