Provider Demographics
NPI:1487836185
Name:KLEBAN, ROSALIND (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSALIND
Middle Name:
Last Name:KLEBAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E 71ST ST STE 1H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5265
Mailing Address - Country:US
Mailing Address - Phone:212-628-3407
Mailing Address - Fax:
Practice Address - Street 1:330 E 71ST ST STE 1H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5265
Practice Address - Country:US
Practice Address - Phone:212-628-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO24766-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN74741Medicare PIN