Provider Demographics
NPI:1699046920
Name:ROSEN, BRACHA TOVAH (SLP)
Entity type:Individual
Prefix:
First Name:BRACHA
Middle Name:TOVAH
Last Name:ROSEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:BRACHA
Other - Middle Name:TOVAH
Other - Last Name:WAHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1735 WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-6200
Mailing Address - Country:US
Mailing Address - Phone:516-297-1456
Mailing Address - Fax:
Practice Address - Street 1:1312 38TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3612
Practice Address - Country:US
Practice Address - Phone:718-686-3560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist