Provider Demographics
NPI:1710065123
Name:UNGARO, ROSEANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSEANN
Middle Name:
Last Name:UNGARO
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 1:45 N STATION PLZ
Mailing Address - Street 2:STE 301
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5007
Mailing Address - Country:US
Mailing Address - Phone:516-521-4217
Mailing Address - Fax:516-629-6882
Practice Address - Street 1:45 N STATION PLZ
Practice Address - Street 2:STE 301
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5007
Practice Address - Country:US
Practice Address - Phone:718-224-1033
Practice Address - Fax:516-676-0521
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007453103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY61305003OtherGHI & VALUE OPTIONS
NY61305Medicare ID - Type UnspecifiedPROVIDER