Provider Demographics
NPI:1659524510
Name:ROZE, INGRID IRENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:IRENE
Last Name:ROZE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 19TH ST
Mailing Address - Street 2:4A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5480
Mailing Address - Country:US
Mailing Address - Phone:718-499-3054
Mailing Address - Fax:718-499-3089
Practice Address - Street 1:249 19TH ST
Practice Address - Street 2:4A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5480
Practice Address - Country:US
Practice Address - Phone:718-499-3054
Practice Address - Fax:718-499-3089
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009920-10103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical