Provider Demographics
NPI:1669700282
Name:ROSEN, MICHELE SUSAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:SUSAN
Last Name:ROSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:SUSAN
Other - Last Name:KAUFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:3671 HUDSON MANOR TER
Mailing Address - Street 2:APT. 10D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1137
Mailing Address - Country:US
Mailing Address - Phone:718-907-3464
Mailing Address - Fax:
Practice Address - Street 1:3265 JOHNSON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3539
Practice Address - Country:US
Practice Address - Phone:718-907-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050763-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker