Provider Demographics
NPI:1871798157
Name:COSGROVE, FREDERICK PAUL (CASAC)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:PAUL
Last Name:COSGROVE
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 OVERLOOK CIR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-4501
Mailing Address - Country:US
Mailing Address - Phone:914-441-8664
Mailing Address - Fax:914-632-2490
Practice Address - Street 1:4401 BRONX BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470
Practice Address - Country:US
Practice Address - Phone:718-304-7047
Practice Address - Fax:718-304-7067
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18186101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)