Provider Demographics
NPI:1730211079
Name:KAVO, ROSE F (LCSW)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:F
Last Name:KAVO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 111TH ST
Mailing Address - Street 2:APT. 14 D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1813
Mailing Address - Country:US
Mailing Address - Phone:212-316-6155
Mailing Address - Fax:212-663-4771
Practice Address - Street 1:50 W 97TH ST
Practice Address - Street 2:SUITE 1 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6053
Practice Address - Country:US
Practice Address - Phone:212-316-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0319071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN2I261Medicare ID - Type Unspecified