Provider Demographics
NPI:1629883327
Name:FARE, ROSA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:FARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:
Other - Last Name:ESCALONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1237
Mailing Address - Country:US
Mailing Address - Phone:518-650-2966
Mailing Address - Fax:
Practice Address - Street 1:820 RIVER ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1237
Practice Address - Country:US
Practice Address - Phone:518-650-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCASAC-T-37598101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)