Provider Demographics
NPI:1124134036
Name:ROUZIE, MITCHELL FRANK (MSW)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:FRANK
Last Name:ROUZIE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1617
Mailing Address - Country:US
Mailing Address - Phone:718-981-6158
Mailing Address - Fax:718-447-8400
Practice Address - Street 1:482 BARD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2105
Practice Address - Country:US
Practice Address - Phone:718-981-6158
Practice Address - Fax:718-447-8400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR062183-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7480477OtherVALUE OPTIONS/GHI
NY227819OtherHEALTHNET/MHN
NY227819OtherHEALTHNET/MHN