Provider Demographics
NPI:1689034506
Name:ROSENZWEIG, DEBRA (PHD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ROSENZWEIG
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 1:301 W 110TH ST
Mailing Address - Street 2:12J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-4066
Mailing Address - Country:US
Mailing Address - Phone:917-697-2139
Mailing Address - Fax:
Practice Address - Street 1:230 W 13TH ST
Practice Address - Street 2:BUZZER L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7746
Practice Address - Country:US
Practice Address - Phone:917-697-2139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT48.0115459103T00000X
NY013905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist