Provider Demographics
NPI:1336474832
Name:ROSIN, MARINA ALEXANDROVNA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:ALEXANDROVNA
Last Name:ROSIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 BRIGHTON 5TH ST
Mailing Address - Street 2:APT. A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8528
Mailing Address - Country:US
Mailing Address - Phone:917-774-6294
Mailing Address - Fax:
Practice Address - Street 1:2114 GRAVESEND NECK RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4810
Practice Address - Country:US
Practice Address - Phone:917-774-6294
Practice Address - Fax:718-332-5314
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078889-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03432368Medicaid