Provider Demographics
NPI:1215011655
Name:ROGALSKY, LILA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LILA
Middle Name:ANN
Last Name:ROGALSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 CROWN ST
Mailing Address - Street 2:BLYYN.N.Y.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5304
Mailing Address - Country:US
Mailing Address - Phone:718-756-7814
Mailing Address - Fax:
Practice Address - Street 1:1600 CENTRAL AVE
Practice Address - Street 2:FAR ROCKAWAY, N.Y.
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4008
Practice Address - Country:US
Practice Address - Phone:718-327-1600
Practice Address - Fax:718-868-4792
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0724081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY007244Medicare ID - Type Unspecified