Provider Demographics
NPI:1033411681
Name:LAVERGNE, ROSA N (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:N
Last Name:LAVERGNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-3513
Mailing Address - Country:US
Mailing Address - Phone:201-446-1898
Mailing Address - Fax:201-490-1753
Practice Address - Street 1:268 EDGEMONT TER
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3404
Practice Address - Country:US
Practice Address - Phone:201-446-1898
Practice Address - Fax:201-490-1753
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37RT00288300101Y00000X
NY000351-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor