Provider Demographics
NPI:1104521178
Name:DE LA ROSA, KATHIUSCA (LMSW)
Entity type:Individual
Prefix:
First Name:KATHIUSCA
Middle Name:
Last Name:DE LA ROSA
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 BRUCKNER BLVD APT 9C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1927
Mailing Address - Country:US
Mailing Address - Phone:347-335-9217
Mailing Address - Fax:
Practice Address - Street 1:3635 BELL BLVD STE 203
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2097
Practice Address - Country:US
Practice Address - Phone:774-773-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126902104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker