Provider Demographics
NPI:1487123287
Name:ROSA, CARMEN CECILIA (LMSW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:CECILIA
Last Name:ROSA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-5384
Mailing Address - Country:US
Mailing Address - Phone:718-497-6090
Mailing Address - Fax:718-497-6262
Practice Address - Street 1:315 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5384
Practice Address - Country:US
Practice Address - Phone:718-497-6090
Practice Address - Fax:718-497-6262
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068605-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06605-1OtherLMSW