Provider Demographics
NPI:1689973406
Name:ROSSISACH, SUSAN (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:ROSSISACH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SOUTH 3RD AVENUE
Mailing Address - Street 2:MT. VERNON SERVICE CENTER
Mailing Address - City:MT. VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550
Mailing Address - Country:US
Mailing Address - Phone:914-699-6070
Mailing Address - Fax:914-699-8295
Practice Address - Street 1:140 OLD ORANGEBURG ROAD
Practice Address - Street 2:ROCKLAND PSYCHIATRIC CENTER
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962
Practice Address - Country:US
Practice Address - Phone:914-699-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035508-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker