Provider Demographics
NPI:1568941219
Name:CASSELL-ROSADO, LARA B (LMSW, LSW)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:B
Last Name:CASSELL-ROSADO
Suffix:
Gender:F
Credentials:LMSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 KEIBER CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2911
Mailing Address - Country:US
Mailing Address - Phone:917-715-2757
Mailing Address - Fax:
Practice Address - Street 1:1765 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3604
Practice Address - Country:US
Practice Address - Phone:718-761-9800
Practice Address - Fax:718-370-1142
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06399400104100000X
NY103860104100000X
NY0947391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker