Healthcare Provider Details

I. General information

NPI: 1972373330
Provider Name (Legal Business Name): THERESA ROKOSZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 JAMES ST STE 100
SYRACUSE NY
13206-2392
US

IV. Provider business mailing address

5854 ROUTE 96 APT 201B
ROMULUS NY
14541-9579
US

V. Phone/Fax

Practice location:
  • Phone: 315-422-0300
  • Fax:
Mailing address:
  • Phone: 315-651-8690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076690
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: