Provider Demographics
NPI:1912522350
Name:SFORZA, ROSE-MARY (CASAC-2)
Entity Type:Individual
Prefix:
First Name:ROSE-MARY
Middle Name:
Last Name:SFORZA
Suffix:
Gender:F
Credentials:CASAC-2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4358 STATE ROUTE 17B
Mailing Address - Street 2:
Mailing Address - City:CALLICOON
Mailing Address - State:NY
Mailing Address - Zip Code:12723-6325
Mailing Address - Country:US
Mailing Address - Phone:914-924-7628
Mailing Address - Fax:
Practice Address - Street 1:17 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1319
Practice Address - Country:US
Practice Address - Phone:845-794-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35460101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)