Provider Demographics
NPI:1962551796
Name:ROSENZWEIG-GOLDMAN, ELLEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:ROSENZWEIG-GOLDMAN
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 1:920 WINTON RD S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1634
Mailing Address - Country:US
Mailing Address - Phone:585-271-6477
Mailing Address - Fax:
Practice Address - Street 1:920 WINTON RD S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1634
Practice Address - Country:US
Practice Address - Phone:585-271-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR01852211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11282BMedicare ID - Type Unspecified