Provider Demographics
NPI:1447499561
Name:ROSE, CARLA JOY (LCSW)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:JOY
Last Name:ROSE
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 1:235 E 87TH ST
Mailing Address - Street 2:APT 4D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3225
Mailing Address - Country:US
Mailing Address - Phone:212-585-3119
Mailing Address - Fax:
Practice Address - Street 1:235 E 87TH ST
Practice Address - Street 2:APT 4D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3225
Practice Address - Country:US
Practice Address - Phone:212-585-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072633-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY072633OtherLCSW STATE LICENSE NUMBER