Provider Demographics
NPI:1477693034
Name:ROSEBERRY, ANNE KATHLEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:KATHLEEN
Last Name:ROSEBERRY
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:3 GATES CIR
Mailing Address - Street 2:CHILD & ADOLESCENT PSYCHIATRY - 8TH FLOOR
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1120
Mailing Address - Country:US
Mailing Address - Phone:716-887-5788
Mailing Address - Fax:716-887-5801
Practice Address - Street 1:3 GATES CIR
Practice Address - Street 2:CHILD & ADOLESCENT PSYCHIATRY - 8TH FLOOR
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1120
Practice Address - Country:US
Practice Address - Phone:716-887-5788
Practice Address - Fax:716-887-5801
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYR026994-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6190467OtherINDEPEN. HEALTH PROV #
NY000590297001OtherBLUE CROSS PROV #