1477693034 NPI number — MS. ANNE KATHLEEN ROSEBERRY LCSW

Table of content: MS. ANNE KATHLEEN ROSEBERRY LCSW (NPI 1477693034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477693034 NPI number — MS. ANNE KATHLEEN ROSEBERRY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSEBERRY
Provider First Name:
ANNE
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477693034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 GATES CIR
Provider Second Line Business Mailing Address:
CHILD & ADOLESCENT PSYCHIATRY - 8TH FLOOR
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14209-1120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-887-5788
Provider Business Mailing Address Fax Number:
716-887-5801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 GATES CIR
Provider Second Line Business Practice Location Address:
CHILD & ADOLESCENT PSYCHIATRY - 8TH FLOOR
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14209-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-887-5788
Provider Business Practice Location Address Fax Number:
716-887-5801
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R026994-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6190467 . This is a "INDEPEN. HEALTH PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000590297001 . This is a "BLUE CROSS PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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