Provider Demographics
NPI:1356783278
Name:ROUSSEAU, KATHY (LCSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:ROUSSEAU
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 1:8 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1357
Mailing Address - Country:US
Mailing Address - Phone:917-541-4000
Mailing Address - Fax:
Practice Address - Street 1:8 GARDEN ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1357
Practice Address - Country:US
Practice Address - Phone:917-541-4000
Practice Address - Fax:845-340-7314
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080768-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical