Provider Demographics
NPI:1447314315
Name:ROSEN, JOANN (LMHC)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:
Last Name:ROSEN
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 1:2 TUDOR DR
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1314
Mailing Address - Country:US
Mailing Address - Phone:631-689-9779
Mailing Address - Fax:
Practice Address - Street 1:28 JONES ST
Practice Address - Street 2:SUITE 204
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2941
Practice Address - Country:US
Practice Address - Phone:631-689-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000044-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health