Individual
KENIA E DE LA ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
452 SUFFOLK AVE, BRENTWOOD, NY 11717-4214
(631) 436-6065
(631) 524-5542
Mailing address
452 SUFFOLK AVE, BRENTWOOD, NY 11717-4214
(631) 436-6065
(631) 524-5542
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
116914-01
NY
Other
Enumeration date
04/18/2025
Last updated
04/18/2025
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