Provider Demographics
NPI:1720419146
Name:ROSENFIELD, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ROSENFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 W BROADWAY
Mailing Address - Street 2:APT 3B
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3945
Mailing Address - Country:US
Mailing Address - Phone:516-660-9166
Mailing Address - Fax:
Practice Address - Street 1:2-12 W PARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2025
Practice Address - Country:US
Practice Address - Phone:516-889-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081366-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical