Provider Demographics
NPI:1750538559
Name:CASSONE, ROCCO A (CRC)
Entity type:Individual
Prefix:MR
First Name:ROCCO
Middle Name:A
Last Name:CASSONE
Suffix:
Gender:M
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DAVENPORT AVE
Mailing Address - Street 2:APT 1L
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3625
Mailing Address - Country:US
Mailing Address - Phone:914-925-5414
Mailing Address - Fax:914-925-5150
Practice Address - Street 1:40 DAVENPORT AVE
Practice Address - Street 2:APT 1L
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-3625
Practice Address - Country:US
Practice Address - Phone:914-925-5414
Practice Address - Fax:914-925-5150
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00055137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00055137OtherCRC CERTIFICATION