Provider Demographics
NPI:1700925245
Name:ROSEN, ROCHELLE F (LCSWR CASAC)
Entity Type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:F
Last Name:ROSEN
Suffix:
Gender:F
Credentials:LCSWR CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MARKET ST
Mailing Address - Street 2:SUITE 508
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-2914
Mailing Address - Country:US
Mailing Address - Phone:716-434-7430
Mailing Address - Fax:716-434-2300
Practice Address - Street 1:20 MARKET ST
Practice Address - Street 2:SUITE 508
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-2914
Practice Address - Country:US
Practice Address - Phone:716-434-7430
Practice Address - Fax:716-434-2300
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0339981104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00332774Medicaid
NY16146909001OtherCIGNA
00020322901OtherUNIVERA
NY040426031013OtherFIDELIS
NY6207261OtherIHA
NY00052308005OtherBC
NY005555OtherVALUE OPTIONS
00020322901OtherUNIVERA