Healthcare Provider Details

I. General information

NPI: 1760216576
Provider Name (Legal Business Name): ROSE ANN GITTENS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 NORTHERN BLVD STE 404#0644
MANHASSET NY
11030-3022
US

IV. Provider business mailing address

2260 GRAND AVE UNIT 240
BALDWIN NY
11510-6010
US

V. Phone/Fax

Practice location:
  • Phone: 631-220-1760
  • Fax:
Mailing address:
  • Phone: 631-220-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number114888
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: