Provider Demographics
NPI:1407646409
Name:ROSENBERG, CARLY EMMA (SLP)
Entity type:Individual
Prefix:MS
First Name:CARLY
Middle Name:EMMA
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10311 68TH DR APT 6D
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3104
Mailing Address - Country:US
Mailing Address - Phone:516-359-2323
Mailing Address - Fax:
Practice Address - Street 1:8268 168TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1328
Practice Address - Country:US
Practice Address - Phone:718-883-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028037235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist