Provider Demographics
NPI:1740568880
Name:ROSENBAUM, ALISON (LMHC)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-0041
Mailing Address - Country:US
Mailing Address - Phone:518-643-6894
Mailing Address - Fax:518-643-8709
Practice Address - Street 1:12 ELM STREET
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NY
Practice Address - Zip Code:12972
Practice Address - Country:US
Practice Address - Phone:518-643-6894
Practice Address - Fax:518-643-8709
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004591-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health