Provider Demographics
NPI:1164446951
Name:ROSEN, GAIL D (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:D
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N DE BAUN AVE
Mailing Address - Street 2:APT. 208
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5125
Mailing Address - Country:US
Mailing Address - Phone:845-357-6797
Mailing Address - Fax:
Practice Address - Street 1:145 N FRANKLIN TPKE
Practice Address - Street 2:SUITE 204
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1602
Practice Address - Country:US
Practice Address - Phone:201-785-8998
Practice Address - Fax:201-961-8989
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051669001041C0700X
NYR-0703641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNI0741Medicare ID - Type Unspecified
NJ112233WSIMedicare PIN
NYP16982Medicare UPIN