Provider Demographics
NPI:1619577541
Name:CARIAS-RODRIGUEZ, JOSSELYN D (CASAC)
Entity Type:Individual
Prefix:
First Name:JOSSELYN
Middle Name:D
Last Name:CARIAS-RODRIGUEZ
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6232
Mailing Address - Country:US
Mailing Address - Phone:516-733-7040
Mailing Address - Fax:516-733-7098
Practice Address - Street 1:90 CHERRY LN
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-6232
Practice Address - Country:US
Practice Address - Phone:516-733-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36572101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)