Provider Demographics
NPI:1225177025
Name:BONTA-ROSKOS, CATHERINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:BONTA-ROSKOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 STEVEN PL
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5419
Mailing Address - Country:US
Mailing Address - Phone:631-835-1570
Mailing Address - Fax:631-737-4506
Practice Address - Street 1:47 STEVEN PL
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5419
Practice Address - Country:US
Practice Address - Phone:631-835-1570
Practice Address - Fax:631-737-4506
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0755921041C0700X
NY1225177025171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1225177025OtherNEW YORK STATE
NY1225177025OtherNEW YORK STATE