Provider Demographics
NPI:1164040580
Name:RICHARDSON, ROSALYN (CASCT)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CASCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2164
Mailing Address - Country:US
Mailing Address - Phone:631-703-8478
Mailing Address - Fax:
Practice Address - Street 1:273 HEBERTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1809
Practice Address - Country:US
Practice Address - Phone:718-412-3170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)