Provider Demographics
NPI:1740343748
Name:BRAMBLE WEED, ROSA MARIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:MARIA
Last Name:BRAMBLE WEED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4322 50TH ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4442
Mailing Address - Country:US
Mailing Address - Phone:718-518-2894
Mailing Address - Fax:718-458-4481
Practice Address - Street 1:4322 50TH ST STE 2C
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4442
Practice Address - Country:US
Practice Address - Phone:718-518-2894
Practice Address - Fax:718-458-4481
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046491104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY273369OtherMHN