Provider Demographics
NPI:1720884539
Name:ROSEN, STEPHANIE (ATR-BC, LCAT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:ROSEN
Suffix:
Gender:
Credentials:ATR-BC, LCAT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:B
Other - Last Name:WIENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:94 OAK DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3314
Mailing Address - Country:US
Mailing Address - Phone:914-523-2379
Mailing Address - Fax:
Practice Address - Street 1:351 MANVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2166
Practice Address - Country:US
Practice Address - Phone:914-523-2379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000619221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist