Provider Demographics
NPI:1699064261
Name:ROSEN, MELISSA EVE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:EVE
Last Name:ROSEN
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 1:69 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3028
Mailing Address - Country:US
Mailing Address - Phone:914-584-0358
Mailing Address - Fax:
Practice Address - Street 1:69 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3028
Practice Address - Country:US
Practice Address - Phone:914-584-0358
Practice Address - Fax:914-584-0358
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081613-11041C0700X
NJ44SC054594001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical