Healthcare Provider Details

I. General information

NPI: 1376527101
Provider Name (Legal Business Name): SANDRA ROSENGARTEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PINE DR
PORT WASHINGTON NY
11050-3403
US

IV. Provider business mailing address

9 PINE DR
PORT WASHINGTON NY
11050-3403
US

V. Phone/Fax

Practice location:
  • Phone: 516-883-0528
  • Fax: 516-883-0528
Mailing address:
  • Phone: 516-883-0528
  • Fax: 516-883-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR043043
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: