Healthcare Provider Details

I. General information

NPI: 1295800563
Provider Name (Legal Business Name): LAURIE S ROSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 COMMACK RD STE H135
COMMACK NY
11725-3442
US

IV. Provider business mailing address

169 COMMACK RD STE H135
COMMACK NY
11725-3442
US

V. Phone/Fax

Practice location:
  • Phone: 631-864-1469
  • Fax: 631-360-0706
Mailing address:
  • Phone: 631-864-1469
  • Fax: 631-360-0706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberRO18514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: