Provider Demographics
NPI:1720736903
Name:MASTROGIACOMO, ROSA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:
Last Name:MASTROGIACOMO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SOUTH RD APT 2D
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-3361
Mailing Address - Country:US
Mailing Address - Phone:914-490-8877
Mailing Address - Fax:
Practice Address - Street 1:210 SUMMIT AVE STE B2
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1526
Practice Address - Country:US
Practice Address - Phone:201-661-3375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093526-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker