Provider Demographics
NPI:1891890273
Name:HALL, ROSEMARIE F (LCSW R)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:F
Last Name:HALL
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 1:8055 SAND RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304
Mailing Address - Country:US
Mailing Address - Phone:315-896-2100
Mailing Address - Fax:
Practice Address - Street 1:8021 ROUTE 12 VILLAGE PLAZA
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304-2507
Practice Address - Country:US
Practice Address - Phone:315-896-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040913 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000917895001OtherHEALTH NOW
NY139015OtherVALUE OPTIONS
NY0252459Medicaid
NY040426031700OtherFIDELRS
NY10083601OtherCDPHP
NY615037OtherMVP HEALTHPLAN
BB9192Medicare ID - Type Unspecified