Provider Demographics
NPI:1467008482
Name:ROSSI, MARY JOANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JOANNE
Last Name:ROSSI
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 1:930 JEFFERSON ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2392
Mailing Address - Country:US
Mailing Address - Phone:203-257-6891
Mailing Address - Fax:
Practice Address - Street 1:74 SAINT MARKS PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-8129
Practice Address - Country:US
Practice Address - Phone:203-257-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1070361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical