Provider Demographics
NPI:1689794307
Name:BOSSO, VINCENT GUY (MSW)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:GUY
Last Name:BOSSO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CLINTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-1404
Mailing Address - Country:US
Mailing Address - Phone:585-232-1840
Mailing Address - Fax:585-770-1116
Practice Address - Street 1:30 CLINTON AVE N
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-1404
Practice Address - Country:US
Practice Address - Phone:585-232-1840
Practice Address - Fax:585-770-1116
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO2229411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical