Provider Demographics
NPI:1780042291
Name:ROSEN, BETH S (MSW CSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:S
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MSW CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W 232ND ST
Mailing Address - Street 2:APT. E62
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3530
Mailing Address - Country:US
Mailing Address - Phone:212-865-2853
Mailing Address - Fax:
Practice Address - Street 1:150 W 95TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6611
Practice Address - Country:US
Practice Address - Phone:212-865-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0185121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical