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NPI Code Detail

MEDICARE: MS. ROSALIE REBECCA YOUNG LCSW

MEDICARE:  MS. ROSALIE REBECCA YOUNG  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerPR006488-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PR006488-1OTHERNYLICENSED CLINICAL SOCIAL WORKER

General Provider Information

NPI Number : 1851644611
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ROSALIE REBECCA YOUNG LCSW
Provider Business Mailing Address
First Line : 4101 E GENESEE ST
Second Line : SYRACUSE JEWISH FAMILY SERVICE AT MENORAH PARK
City : SYRACUSE
State : NY
Zip : 13214-2136
Country : US
Telephone Number : 315-446-9111
Fax Number : 315-446-1537
Provider Business Practice Location Address
First Line : 4101 E GENESEE ST
Second Line : SYRACUSE JEWISH FAMILY SERVICE AT MENORAH PARK
City : SYRACUSE
State : NY
Zip : 13214-2136
Country : US
Telephone Number : 315-446-9111
Fax Number : 315-446-1537
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2012
Last Update Date : 10/17/2012

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