=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295530632
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE ROSENFELD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2025
-----------------------------------------------------
Last Update Date | 02/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 444 E BOSTON POST RD STE 201
-----------------------------------------------------
City | MAMARONECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10543-3704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-834-1777
-----------------------------------------------------
Fax | 914-834-0047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 444 E BOSTON POST RD STE 201
-----------------------------------------------------
City | MAMARONECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10543-3704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-834-1777
-----------------------------------------------------
Fax | 914-834-0047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 126114
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------