Provider Demographics
NPI:1073104733
Name:DAVID, ROSE-ELLEN (LCAT)
Entity type:Individual
Prefix:MS
First Name:ROSE-ELLEN
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 87TH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4806
Mailing Address - Country:US
Mailing Address - Phone:212-534-0099
Mailing Address - Fax:
Practice Address - Street 1:301 E 87TH ST APT 2A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4806
Practice Address - Country:US
Practice Address - Phone:212-534-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000082221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist