Healthcare Provider Details

I. General information

NPI: 1790520146
Provider Name (Legal Business Name): EMILY ROSA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2083 WHITNEY AVE
NORTH HAVEN CT
06473-4359
US

IV. Provider business mailing address

2083 WHITNEY AVE
NORTH HAVEN CT
06473-4359
US

V. Phone/Fax

Practice location:
  • Phone: 347-651-2017
  • Fax:
Mailing address:
  • Phone: 347-651-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123536
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: