Provider Demographics
NPI:1437530714
Name:ROSENBERG, TISS
Entity Type:Individual
Prefix:
First Name:TISS
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 RIVERSIDE DR
Mailing Address - Street 2:#11A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2219
Mailing Address - Country:US
Mailing Address - Phone:212-534-0051
Mailing Address - Fax:
Practice Address - Street 1:155 RIVERSIDE DR
Practice Address - Street 2:#11A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2219
Practice Address - Country:US
Practice Address - Phone:212-534-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074697-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical