Provider Demographics
NPI:1861776783
Name:BUSTOS, YOLANDA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:
Last Name:BUSTOS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 ONTARIO CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:NY
Mailing Address - Zip Code:14568-9727
Mailing Address - Country:US
Mailing Address - Phone:315-986-7521
Mailing Address - Fax:
Practice Address - Street 1:131 W BROAD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-1103
Practice Address - Country:US
Practice Address - Phone:585-262-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084321-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool