Provider Demographics
NPI:1407063894
Name:ROSNO, MICHAEL SHAWN (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL SHAWN
Middle Name:
Last Name:ROSNO
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 YAWGER HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14815-9662
Mailing Address - Country:US
Mailing Address - Phone:607-583-4997
Mailing Address - Fax:
Practice Address - Street 1:77 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2715
Practice Address - Country:US
Practice Address - Phone:607-936-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0746601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16-1540089OtherTAX NUMBER )