Provider Demographics
NPI:1386979987
Name:JUDI F. ROZSA LCSW CASAC P.C.
Entity type:Organization
Organization Name:JUDI F. ROZSA LCSW CASAC P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROZSA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CASAC
Authorized Official - Phone:315-422-0671
Mailing Address - Street 1:753 JAMES ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2108
Mailing Address - Country:US
Mailing Address - Phone:315-422-0671
Mailing Address - Fax:
Practice Address - Street 1:753 JAMES ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2108
Practice Address - Country:US
Practice Address - Phone:315-422-0671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 104100000X, 106H00000X, 251S00000X
NY1268101YA0400X
NY003200-1101YM0800X
NY001790-1101YM0800X
NYRO30818-11041C0700X
NYPRO14651-11041C0700X
NY000210-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01706147Medicaid
NY56711Medicare UPIN