Provider Demographics
NPI:1750504643
Name:ROSE, ESTA H (LCSW)
Entity Type:Individual
Prefix:
First Name:ESTA
Middle Name:H
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E 96TH ST
Mailing Address - Street 2:15B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0730
Mailing Address - Country:US
Mailing Address - Phone:212-876-8923
Mailing Address - Fax:212-876-6468
Practice Address - Street 1:65 E 96TH ST
Practice Address - Street 2:15B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0730
Practice Address - Country:US
Practice Address - Phone:212-876-8923
Practice Address - Fax:212-876-6468
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0300461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical