Provider Demographics
NPI:1346390366
Name:ROSENVINGE, ALFRED T (LCSW-R, ACSW)
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:T
Last Name:ROSENVINGE
Suffix:
Gender:M
Credentials:LCSW-R, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:49 WEST FORT SALONGA ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768
Mailing Address - Country:US
Mailing Address - Phone:631-754-6425
Mailing Address - Fax:631-754-6425
Practice Address - Street 1:500 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8219
Practice Address - Country:US
Practice Address - Phone:631-665-7701
Practice Address - Fax:631-665-7701
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036135-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical