Healthcare Provider Details

I. General information

NPI: 1760606180
Provider Name (Legal Business Name): ANDREW E ROFFMAN ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 1ST AVE
NEW YORK NY
10016-6404
US

IV. Provider business mailing address

577 1ST AVE
NEW YORK NY
10016-6404
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-6567
  • Fax:
Mailing address:
  • Phone: 212-263-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR039019
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: