Provider Demographics
NPI:1538478219
Name:LAURENCE ROSEN LCSW LLC
Entity Type:Organization
Organization Name:LAURENCE ROSEN LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCSW
Authorized Official - Phone:973-783-8673
Mailing Address - Street 1:16 MOUNTAINSIDE PARK TER
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1209
Mailing Address - Country:US
Mailing Address - Phone:973-783-8673
Mailing Address - Fax:
Practice Address - Street 1:16 MOUNTAINSIDE PARK TER
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1209
Practice Address - Country:US
Practice Address - Phone:973-783-8673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty