Provider Demographics
NPI:1639453970
Name:ROSENFELD, ALISA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:
Last Name:ROSENFELD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ROCKHILL RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1420
Mailing Address - Country:US
Mailing Address - Phone:516-621-6516
Mailing Address - Fax:
Practice Address - Street 1:59 ROCKHILL RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1420
Practice Address - Country:US
Practice Address - Phone:516-621-6516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010320-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist