Provider Demographics
NPI:1154897270
Name:ROSSI, TRISHA (LCSW)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:ROSSI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 OCEAN AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1924
Mailing Address - Country:US
Mailing Address - Phone:631-807-5929
Mailing Address - Fax:
Practice Address - Street 1:1500 OCEAN AVE STE D
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1924
Practice Address - Country:US
Practice Address - Phone:631-807-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079274-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical