Provider Demographics
NPI:1841563871
Name:ROSEN, ILANA H (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:ILANA
Middle Name:H
Last Name:ROSEN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MARCIA LANE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-2018
Mailing Address - Country:US
Mailing Address - Phone:845-499-0725
Mailing Address - Fax:845-371-6381
Practice Address - Street 1:3 MARCIA LANE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-2018
Practice Address - Country:US
Practice Address - Phone:845-499-0725
Practice Address - Fax:845-371-6381
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0759101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical