Provider Demographics
NPI:1316965312
Name:ROSENBERG, MARILYN (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RING RD
Mailing Address - Street 2:
Mailing Address - City:SALT POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12578-2227
Mailing Address - Country:US
Mailing Address - Phone:845-266-3193
Mailing Address - Fax:
Practice Address - Street 1:100 RING RD
Practice Address - Street 2:
Practice Address - City:SALT POINT
Practice Address - State:NY
Practice Address - Zip Code:12578-2227
Practice Address - Country:US
Practice Address - Phone:845-266-3193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO41583-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN38S91Medicare ID - Type Unspecified
NYQ62267Medicare UPIN