Provider Demographics
NPI:1164529236
Name:ROSEN, CHARLES M (LCSW)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:ROSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:98 RIVERSIDE DR
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5323
Mailing Address - Country:US
Mailing Address - Phone:212-595-4674
Mailing Address - Fax:212-724-1442
Practice Address - Street 1:98 RIVERSIDE DR
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5323
Practice Address - Country:US
Practice Address - Phone:212-595-4674
Practice Address - Fax:212-724-1442
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR019846-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02333246Medicaid
11237560OtherCAQH
NY02333246Medicaid
11237560OtherCAQH