MEDICARE: MS. EUGENIA M ROSSI 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
1	1041C0700X	Clinical Social Worker	RO45909-1	NY

General Provider Information

NPI Number	:	1790900421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EUGENIA M ROSSI LCSW

Provider Business Mailing Address
First Line	:	322 MORNINGSTAR RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-2831
Country	:	US
Telephone Number	:	718-876-1710
Fax Number	:

Provider Business Practice Location Address
First Line	:	1036 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3622
Country	:	US
Telephone Number	:	908-240-8496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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