Provider Demographics
NPI:1447456009
Name:ROUSE, LUONNE ABRAM (DMIN)
Entity type:Individual
Prefix:DR
First Name:LUONNE
Middle Name:ABRAM
Last Name:ROUSE
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1532
Mailing Address - Country:US
Mailing Address - Phone:212-289-6157
Mailing Address - Fax:212-289-2368
Practice Address - Street 1:1975 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1532
Practice Address - Country:US
Practice Address - Phone:212-289-6157
Practice Address - Fax:212-289-2368
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000599-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist