Healthcare Provider Details

I. General information

NPI: 1629257209
Provider Name (Legal Business Name): MARCIA ROSEN, PH.D.,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 E 82ND ST APT. 5B
NEW YORK NY
10028-0344
US

IV. Provider business mailing address

24 E 82ND ST APT. 5B
NEW YORK NY
10028-0344
US

V. Phone/Fax

Practice location:
  • Phone: 212-535-6657
  • Fax: 212-988-7433
Mailing address:
  • Phone: 212-535-6657
  • Fax: 212-988-7433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number004093-1
License Number StateNY

VIII. Authorized Official

Name: DR. MARCIA ROSEN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 212-535-6657