Provider Demographics
NPI:1164550869
Name:ROSNICK, PHILLIDA BROWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIDA
Middle Name:BROWN
Last Name:ROSNICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E 86TH ST
Mailing Address - Street 2:SUITE 12C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1058
Mailing Address - Country:US
Mailing Address - Phone:212-828-0255
Mailing Address - Fax:212-249-0763
Practice Address - Street 1:103 E 86TH ST
Practice Address - Street 2:SUITE 12C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1058
Practice Address - Country:US
Practice Address - Phone:212-828-0255
Practice Address - Fax:212-249-0763
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6215103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical