Provider Demographics
NPI:1083972657
Name:ROSENBERG MASS, JULIE M (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:M
Last Name:ROSENBERG MASS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ORANGE DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1529
Mailing Address - Country:US
Mailing Address - Phone:516-637-1308
Mailing Address - Fax:
Practice Address - Street 1:69 ORANGE DR
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1529
Practice Address - Country:US
Practice Address - Phone:516-637-1308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010188-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist