Individual
MR. LIBERATO DEROSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.A.S.A.C.
Contact information
Practice address
2075 NEW YORK AVE, HUNTINGTON STATION, NY 11746-3238
(631) 351-7112
Mailing address
2226 1ST AVE, RONKONKOMA, NY 11779-6239
(631) 445-5373
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
9207
NY
Other
Enumeration date
05/04/2007
Last updated
07/08/2007
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