MEDICARE: THELMA MOLLY ROSENBERG LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	RO47730-1	NY

General Provider Information

NPI Number	:	1437171733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THELMA MOLLY ROSENBERG LCSW

Provider Business Mailing Address
First Line	:	8315 LEFFERTS BLVD
Second Line	:	SUITE 2J
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2520
Country	:	US
Telephone Number	:	718-577-0007
Fax Number	:	718-577-0007

Provider Business Practice Location Address
First Line	:	8315 LEFFERTS BLVD
Second Line	:	SUITE 2J
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2520
Country	:	US
Telephone Number	:	718-577-0007
Fax Number	:	718-577-0007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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