Provider Demographics
NPI:1477267524
Name:ROSETO, NICHOLAS VALENTINO JR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:VALENTINO
Last Name:ROSETO
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6435
Mailing Address - Country:US
Mailing Address - Phone:631-219-5275
Mailing Address - Fax:
Practice Address - Street 1:201 N CLINTON AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6435
Practice Address - Country:US
Practice Address - Phone:631-219-5275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116242104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY81-2508879Medicaid