=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801261268
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSIMAR JEWELL DAUS LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2015
-----------------------------------------------------
Last Update Date | 11/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1461 WASHINGTON ST
-----------------------------------------------------
City | CORTLANDT MANOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10567-6348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-552-5554
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1461 WASHINGTON ST
-----------------------------------------------------
City | CORTLANDT MANOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10567-6348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-552-5554
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 2139
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 3196
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------