Healthcare Provider Details

I. General information

NPI: 1669200564
Provider Name (Legal Business Name): CORRINE ROSENFELD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SAINT MARKS PL
NEW YORK NY
10003-7902
US

IV. Provider business mailing address

250 E 40TH ST APT 5F
NEW YORK NY
10016-1722
US

V. Phone/Fax

Practice location:
  • Phone: 212-982-3470
  • Fax:
Mailing address:
  • Phone: 561-654-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number124265-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: