Provider Demographics
NPI:1427822295
Name:ROUSSEAU, NANCY (LMSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 UNION BLVD APT 18A
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3167
Mailing Address - Country:US
Mailing Address - Phone:917-609-8468
Mailing Address - Fax:
Practice Address - Street 1:13 MCWHORTER ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-3207
Practice Address - Country:US
Practice Address - Phone:631-446-1950
Practice Address - Fax:631-446-1952
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1182671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical