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General NPI Number Information
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NPI Number | 1124237623
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Entity Type | Individual
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Provider Name | ROSETTE LACRECIA RANDALL LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 119 W 124TH ST 6TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10027-4920
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Country | US
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Telephone | 917-386-1799
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Fax | 212-865-2491
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Provider Business Mailing Address
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Address Line | 1655 FLATBUSH AVE
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City | BROOKLYN
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State | NY
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Zip | 11210-3276
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Country | US
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Telephone | 718-513-6902
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 066766-1
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License Number State | NY
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