Provider Demographics
NPI:1679648760
Name:JUDITH F ROZSA MSW CSW CAC PC
Entity Type:Organization
Organization Name:JUDITH F ROZSA MSW CSW CAC PC
Other - Org Name:CLINICAL COUNSELING ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROZSA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW ACSW CASAC
Authorized Official - Phone:315-422-0571
Mailing Address - Street 1:770 JAMES STREET
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203
Mailing Address - Country:US
Mailing Address - Phone:315-422-0571
Mailing Address - Fax:315-422-2734
Practice Address - Street 1:770 JAMES STREET
Practice Address - Street 2:SUITE 215
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-422-0571
Practice Address - Fax:315-422-2734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01706147Medicaid
NY56711Medicare ID - Type Unspecified