Provider Demographics
NPI:1700596152
Name:ROSA, ERICA MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:ROSA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8623 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2131
Mailing Address - Country:US
Mailing Address - Phone:347-681-1312
Mailing Address - Fax:
Practice Address - Street 1:8623 102ND AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2131
Practice Address - Country:US
Practice Address - Phone:347-681-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012938101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health