Provider Demographics
NPI:1437171733
Name:ROSENBERG, THELMA MOLLY (LCSW)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:MOLLY
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TEDDI
Other - Middle Name:
Other - Last Name:ROSENBERG-AMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:8315 LEFFERTS BLVD
Mailing Address - Street 2:SUITE 2J
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2520
Mailing Address - Country:US
Mailing Address - Phone:718-577-0007
Mailing Address - Fax:718-577-0007
Practice Address - Street 1:8315 LEFFERTS BLVD
Practice Address - Street 2:SUITE 2J
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2520
Practice Address - Country:US
Practice Address - Phone:718-577-0007
Practice Address - Fax:718-577-0007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO47730-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNO8U51Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY07011Medicare ID - Type UnspecifiedGHI MEDICARE