Provider Demographics
NPI:1790997062
Name:ROSEN, IRIS A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:A
Last Name:ROSEN
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 1:759 PRESIDENT ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1360
Mailing Address - Country:US
Mailing Address - Phone:212-938-4040
Mailing Address - Fax:212-938-4037
Practice Address - Street 1:299 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6317
Practice Address - Country:US
Practice Address - Phone:212-938-4040
Practice Address - Fax:212-938-4037
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0448391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY140351OtherPROVIDER NUMBER