Provider Demographics
NPI:1366583494
Name:ROSSEN, ROBERT M (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:ROSSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25519 W END DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1049
Mailing Address - Country:US
Mailing Address - Phone:718-801-7180
Mailing Address - Fax:516-467-4460
Practice Address - Street 1:25517 NORTHERN BLVD
Practice Address - Street 2:SUITE B2
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1453
Practice Address - Country:US
Practice Address - Phone:718-801-7180
Practice Address - Fax:516-467-4460
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013746-1103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent