Provider Demographics
NPI:1336778703
Name:ROSASCO, LINDA S (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:ROSASCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1310
Mailing Address - Country:US
Mailing Address - Phone:631-708-4843
Mailing Address - Fax:
Practice Address - Street 1:646 MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2230
Practice Address - Country:US
Practice Address - Phone:516-580-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0886491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical