Provider Demographics
NPI:1922371855
Name:ROSELLO, MICHELE EMILIA (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:EMILIA
Last Name:ROSELLO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:EMILIA
Other - Last Name:SOKOLSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1017 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4744
Mailing Address - Country:US
Mailing Address - Phone:516-286-4620
Mailing Address - Fax:
Practice Address - Street 1:65 PROSPECT AVENUE
Practice Address - Street 2:9W
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557
Practice Address - Country:US
Practice Address - Phone:516-732-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074122-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN3O901OtherMEDICARE PART B