Provider Demographics
NPI:1114431673
Name:SANCHEZ, ROSA IRENE
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:IRENE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 NOSTRAND AVE APT 424
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4010
Mailing Address - Country:US
Mailing Address - Phone:516-200-4798
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 409
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1134
Practice Address - Country:US
Practice Address - Phone:516-200-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13-3303089Medicaid