Basic Information
| Provider Information | |||||||||
| NPI: | 1477745107 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROOSA COUNSELING SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 758 | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109400758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453425789 | ||||||||
| FaxNumber: | 8453440510 | ||||||||
| Practice Location | |||||||||
| Address1: | 334 ROCK HILL DRIVE | ||||||||
| Address2: | |||||||||
| City: | ROCK HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457915789 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2007 | ||||||||
| LastUpdateDate: | 08/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | VILLANUEVA-CRUZ | ||||||||
| AuthorizedOfficialFirstName: | LOURDES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8453425789 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 561845 | 01 | NY | VALUE OPTIONS | OTHER |