MEDICARE: ROSALIND ROSE L.C.S.W.

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	PR021593-1	NY

General Provider Information

NPI Number	:	1326040031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALIND ROSE L.C.S.W.

Provider Business Mailing Address
First Line	:	366 N BROADWAY
Second Line	:	SUITE 404
City	:	JERICHO
State	:	NY
Zip	:	11753-2025
Country	:	US
Telephone Number	:	516-935-0068
Fax Number	:

Provider Business Practice Location Address
First Line	:	366 N BROADWAY
Second Line	:	SUITE 404
City	:	JERICHO
State	:	NY
Zip	:	11753-2025
Country	:	US
Telephone Number	:	516-935-0068
Fax Number	:

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/08/2007

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Directions to “ ROSALIND ROSE L.C.S.W.” Practice Location

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