Provider Demographics
NPI:1386853554
Name:DE ROSA, THOMAS (MA, CRC, LMHC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:DE ROSA
Suffix:
Gender:M
Credentials:MA, CRC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E 81ST ST
Mailing Address - Street 2:1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-5103
Mailing Address - Country:US
Mailing Address - Phone:646-422-1171
Mailing Address - Fax:
Practice Address - Street 1:415 E 81ST ST
Practice Address - Street 2:1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-5103
Practice Address - Country:US
Practice Address - Phone:646-422-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18002070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health