Provider Demographics
NPI:1174638761
Name:DAGOSTINO, ROSEMARY BARBARA (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:BARBARA
Last Name:DAGOSTINO
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PRINCETON PLACE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-662-1933
Mailing Address - Fax:716-662-2315
Practice Address - Street 1:21 PRINCETON PLACE
Practice Address - Street 2:SUITE 1A
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-662-1933
Practice Address - Fax:716-662-2315
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008893103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC8868Medicare ID - Type Unspecified