Healthcare Provider Details

I. General information

NPI: 1881181527
Provider Name (Legal Business Name): CHESKIE ROSENZWEIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CLARK ST
SOMERVILLE MA
02143-3919
US

IV. Provider business mailing address

1439 E 19TH ST
BROOKLYN NY
11230-6715
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1183
  • Fax:
Mailing address:
  • Phone: 347-631-5377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10001194
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: