Provider Demographics
NPI:1932644242
Name:ROSENBERG, LESLIE HANNAH (LMSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:HANNAH
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 NORTHERN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5335
Mailing Address - Country:US
Mailing Address - Phone:516-918-6316
Mailing Address - Fax:516-622-5005
Practice Address - Street 1:865 NORTHERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5335
Practice Address - Country:US
Practice Address - Phone:516-918-6316
Practice Address - Fax:516-622-5005
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0931451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical