Provider Demographics
NPI:1528179900
Name:RETTENBERG, ANNE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:ELIZABETH
Last Name:RETTENBERG
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 1:201 EAST 25TH STREET
Mailing Address - Street 2:#4K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3005
Mailing Address - Country:US
Mailing Address - Phone:212-686-9727
Mailing Address - Fax:212-481-7376
Practice Address - Street 1:132 EAST 22ND STREET
Practice Address - Street 2:SUITE P2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3005
Practice Address - Country:US
Practice Address - Phone:212-686-9727
Practice Address - Fax:212-481-7376
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR044491104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02468000Medicaid
N1K102Medicare ID - Type Unspecified