MEDICARE: JANIQUE ROSA LMSW, CASAC 2

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		NY
2	104100000X	Social Worker	082910	NY

General Provider Information

NPI Number	:	1083145403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIQUE ROSA LMSW, CASAC 2

Provider Business Mailing Address
First Line	:	2932 FENTON AVE FL 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2932 FENTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5506
Country	:	US
Telephone Number	:	917-859-3376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	03/02/2026

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