Provider Demographics
NPI:1275329807
Name:DE LA ROSA, KENIA E (LMSW)
Entity type:Individual
Prefix:
First Name:KENIA
Middle Name:E
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 1:452 SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4214
Mailing Address - Country:US
Mailing Address - Phone:631-436-6065
Mailing Address - Fax:631-524-5542
Practice Address - Street 1:452 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4214
Practice Address - Country:US
Practice Address - Phone:631-436-6065
Practice Address - Fax:631-524-5542
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116914-01101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)