Provider Demographics
NPI:1629115209
Name:ROSEN, PENNY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:PENENA
Other - Middle Name:P
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:7 W 96TH ST
Mailing Address - Street 2:IF
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6540
Mailing Address - Country:US
Mailing Address - Phone:212-721-7010
Mailing Address - Fax:
Practice Address - Street 1:7 W 96TH ST
Practice Address - Street 2:1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6540
Practice Address - Country:US
Practice Address - Phone:212-721-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03226811041C0700X
NJ44SC001895001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN57831Medicare ID - Type Unspecified