Individual
YAACOV J. ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
5 CARAVAN DR, EAST NORTHPORT, NY 11731-3814
(631) 368-7722
(631) 368-7722
Mailing address
5 CARAVAN DR, EAST NORTHPORT, NY 11731-3814
(631) 368-7722
(631) 368-7722
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
005439
NY
Other
Enumeration date
05/16/2010
Last updated
05/16/2010
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