Provider Demographics
NPI:1730312661
Name:ROSEN, STEPHANIE WEXELBAUM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:WEXELBAUM
Last Name:ROSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CENTRAL PARK SOUTH
Mailing Address - Street 2:SUITE 2H-A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4722
Mailing Address - Country:US
Mailing Address - Phone:917-687-6232
Mailing Address - Fax:
Practice Address - Street 1:240 CENTRAL PARK SOUTH
Practice Address - Street 2:SUITE 2H-A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4722
Practice Address - Country:US
Practice Address - Phone:917-687-6232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018074103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical