Provider Demographics
NPI:1104393503
Name:ROSENBERG, JAMIE (CASAC-T)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E 92ND ST BSMT
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1620
Mailing Address - Country:US
Mailing Address - Phone:646-250-0278
Mailing Address - Fax:
Practice Address - Street 1:116 E 92ND ST BSMT
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1620
Practice Address - Country:US
Practice Address - Phone:646-250-0278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100136367Medicaid