Provider Demographics
NPI:1871950949
Name:ROUSH, KATIE (LCSW-R)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:ROUSH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SUTTON RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-7248
Mailing Address - Country:US
Mailing Address - Phone:607-742-6562
Mailing Address - Fax:
Practice Address - Street 1:1133B WILLOW ST
Practice Address - Street 2:STE 4
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2806
Practice Address - Country:US
Practice Address - Phone:607-207-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0784361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical