Provider Demographics
NPI:1851644611
Name:YOUNG, ROSALIE REBECCA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:REBECCA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ROSALIE
Other - Middle Name:REBECCA
Other - Last Name:GARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW
Mailing Address - Street 1:4101 E GENESEE ST
Mailing Address - Street 2:SYRACUSE JEWISH FAMILY SERVICE AT MENORAH PARK
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2136
Mailing Address - Country:US
Mailing Address - Phone:315-446-9111
Mailing Address - Fax:315-446-1537
Practice Address - Street 1:4101 E GENESEE ST
Practice Address - Street 2:SYRACUSE JEWISH FAMILY SERVICE AT MENORAH PARK
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-2136
Practice Address - Country:US
Practice Address - Phone:315-446-9111
Practice Address - Fax:315-446-1537
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR006488-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPR006488-1OtherLICENSED CLINICAL SOCIAL WORKER