Provider Demographics
NPI:1700548211
Name:GUNGOR, ROSEANN
Entity Type:Individual
Prefix:
First Name:ROSEANN
Middle Name:
Last Name:GUNGOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-3615
Mailing Address - Country:US
Mailing Address - Phone:516-287-1100
Mailing Address - Fax:
Practice Address - Street 1:2542 NELSON DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-3615
Practice Address - Country:US
Practice Address - Phone:516-287-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst