MEDICARE: ROBIN JAMES ROSENDALE LMHC

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	101YM0800X	Mental Health Counselor	004671-1	NY

General Provider Information

NPI Number	:	1275817272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN JAMES ROSENDALE LMHC

Provider Business Mailing Address
First Line	:	356 WEST 18TH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-4462
Country	:	US
Telephone Number	:	646-588-1387
Fax Number	:

Provider Business Practice Location Address
First Line	:	356 WEST 18TH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-4462
Country	:	US
Telephone Number	:	646-588-1387
Fax Number	:

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

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	10/10/2011

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