Provider Demographics
NPI:1912461203
Name:MILLS, ROSAMUND CASSANDRA (LCNHC)
Entity Type:Individual
Prefix:MS
First Name:ROSAMUND
Middle Name:CASSANDRA
Last Name:MILLS
Suffix:
Gender:F
Credentials:LCNHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-0268
Mailing Address - Country:US
Mailing Address - Phone:917-923-3963
Mailing Address - Fax:
Practice Address - Street 1:83 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-666-1951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009053-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health