Provider Demographics
NPI:1972884591
Name:MCAVOY, ROSAMOND I (LMSW)
Entity type:Individual
Prefix:
First Name:ROSAMOND
Middle Name:I
Last Name:MCAVOY
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 1:80 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4360
Mailing Address - Country:US
Mailing Address - Phone:607-725-6798
Mailing Address - Fax:
Practice Address - Street 1:218 STONE ST FL 2
Practice Address - Street 2:COMMUNITY CLINIC OF JEFFERSON COUNTY
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3211
Practice Address - Country:US
Practice Address - Phone:315-782-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082459104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker