Provider Demographics
NPI:1366519688
Name:FEDER, ROSALIE L (MSW RCSW)
Entity type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:L
Last Name:FEDER
Suffix:
Gender:F
Credentials:MSW RCSW
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:L
Other - Last Name:BURSTYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 CAMBRIDGE RD
Mailing Address - Street 2:134 MIDDLENECK RD.
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2217
Mailing Address - Country:US
Mailing Address - Phone:516-466-8562
Mailing Address - Fax:516-466-8562
Practice Address - Street 1:134 MIDDLENECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-466-8562
Practice Address - Fax:516-466-8562
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR00198211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0091915OtherGHI
NY02027998Medicaid
6209778OtherUBH
2047401OtherCIGNA
001982OtherHIP
5665725OtherAETNA
011019OtherVALUE OPTIONS
P801669OtherOXFORD
001982OtherHIP
NYNC7891Medicare ID - Type Unspecified