Healthcare Provider Details

I. General information

NPI: 1295530632
Provider Name (Legal Business Name): JACQUELINE ROSENFELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 E BOSTON POST RD STE 201
MAMARONECK NY
10543-3704
US

IV. Provider business mailing address

444 E BOSTON POST RD STE 201
MAMARONECK NY
10543-3704
US

V. Phone/Fax

Practice location:
  • Phone: 914-834-1777
  • Fax: 914-834-0047
Mailing address:
  • Phone: 914-834-1777
  • Fax: 914-834-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number126114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: