Provider Demographics
NPI:1932273638
Name:ROSKAM, DOROTHY (MSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:ROSKAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 WASHINGTON ST APT GA
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3339
Mailing Address - Country:US
Mailing Address - Phone:212-924-6938
Mailing Address - Fax:
Practice Address - Street 1:1 CHRISTOPHER ST APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3582
Practice Address - Country:US
Practice Address - Phone:212-924-5886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0486581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR048658OtherSOCIAL WORK