Provider Demographics
NPI:1790871945
Name:ROZENBERG, EUGENIA S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:EUGENIA
Middle Name:S
Last Name:ROZENBERG
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 1:1610 AVENUE P
Mailing Address - Street 2:APP. 3-O
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1153
Mailing Address - Country:US
Mailing Address - Phone:718-336-5066
Mailing Address - Fax:718-336-5066
Practice Address - Street 1:2020 CONEY ISLAND AVE
Practice Address - Street 2:MIDBROOKLYN CLINIC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2329
Practice Address - Country:US
Practice Address - Phone:718-676-4221
Practice Address - Fax:718-676-4216
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055132-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00055132Medicaid
NY00055132Medicaid