Provider Demographics
NPI:1568558641
Name:ROSE, LINDA MARIA (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIA
Last Name:ROSE
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 1:71 RANSOM AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-2025
Mailing Address - Country:US
Mailing Address - Phone:516-671-7786
Mailing Address - Fax:516-671-7786
Practice Address - Street 1:101 HILLSIDE AVE STE D
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2310
Practice Address - Country:US
Practice Address - Phone:516-671-7786
Practice Address - Fax:516-671-7786
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037295-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN61492Medicare ID - Type UnspecifiedNY MEDICARE NUMBER