Provider Demographics
NPI:1811010150
Name:ROSENBERGER, JUDITH BRAILEY (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:BRAILEY
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:B
Other - Last Name:ROSENBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1165 5TH AVE
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6931
Mailing Address - Country:US
Mailing Address - Phone:212-987-8239
Mailing Address - Fax:
Practice Address - Street 1:1165 5TH AVE
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6931
Practice Address - Country:US
Practice Address - Phone:212-987-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2038103T00000X
NYR0188791041C0700X
NYN177C11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR018879OtherLIC CLINICAL SOCIAL WORK
MA2038OtherPSYCHOLOGIST PROVIDER
MA2038OtherPSYCHOLOGIST PROVIDER