Provider Demographics
NPI:1528574522
Name:ASCENZI, ROBERTO (MHC LIMITED PERMIT)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:ASCENZI
Suffix:
Gender:M
Credentials:MHC LIMITED PERMIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 1ST ST STE 4
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3692
Mailing Address - Country:US
Mailing Address - Phone:315-820-0186
Mailing Address - Fax:315-295-2549
Practice Address - Street 1:300 W 1ST ST STE 4
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3692
Practice Address - Country:US
Practice Address - Phone:315-820-0186
Practice Address - Fax:315-295-2549
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP08625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health