Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 05337 | IN |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 6489 | NY |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | B5337 | IN |
N | 102L00000X | Psychologist | R055692-1 | NY |
N | 103T00000X | Psychologist | R055692-1 | NY |
Y | 1041C0700X | Clinical Social Worker | 29541 | NY |
N | 1041C0700X | Clinical Social Worker | R055692-1 | NY |
NPI | 1003040064 |
---|---|
Provider Name | Mr. Joseph Charles Roccosalvo |
First Address | Huntington, NY 11743-4344 |
Second Address | Huntington, NY 11743-4344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2009 |
Last Update Date | 08/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29541 | BOARD CERTIFIED DIPLOMATE IN CLINICAL SOCIAL WORK (01) | NY |
6489 | CREDENTIALED ALCOHOLISM AND SUBSTANCE ABUSE COUNSELOR (01) | NY |
R055692-1 | REGISTERED LICENSED CLINICAL SOCIAL WORKER (01) | NY |