Healthcare Provider Details

I. General information

NPI: 1699488049
Provider Name (Legal Business Name): MISS TALIA ROSENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 LEXINGTON AVE FL 26
NEW YORK NY
10174-2699
US

IV. Provider business mailing address

405 LEXINGTON AVE STE 2627
NEW YORK NY
10174-0002
US

V. Phone/Fax

Practice location:
  • Phone: 347-852-3318
  • Fax:
Mailing address:
  • Phone: 212-597-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06525000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number015521
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101556
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: