Provider Demographics
NPI:1588794127
Name:ROSENBERG, SUSAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W 30TH ST
Mailing Address - Street 2:1011
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2754
Mailing Address - Country:US
Mailing Address - Phone:917-216-3054
Mailing Address - Fax:
Practice Address - Street 1:286 5TH AVE
Practice Address - Street 2:10TH FLOOR, ROOM I
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4512
Practice Address - Country:US
Practice Address - Phone:212-929-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR30541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN97501Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER