Provider Demographics
NPI:1710253505
Name:RAGOZZINO, AMANDA (CASAC-T)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:RAGOZZINO
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NEVADA STREET
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1622
Mailing Address - Country:US
Mailing Address - Phone:631-369-0104
Mailing Address - Fax:631-369-5433
Practice Address - Street 1:12 NEVADA ST
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-1622
Practice Address - Country:US
Practice Address - Phone:631-369-0104
Practice Address - Fax:631-369-5433
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25676101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)