Basic Information
| Provider Information | |||||||||
| NPI: | 1477693034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSEBERRY | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | KATHLEEN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 GATES CIR | ||||||||
| Address2: | CHILD & ADOLESCENT PSYCHIATRY - 8TH FLOOR | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142091120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168875788 | ||||||||
| FaxNumber: | 7168875801 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 GATES CIR | ||||||||
| Address2: | CHILD & ADOLESCENT PSYCHIATRY - 8TH FLOOR | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142091120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168875788 | ||||||||
| FaxNumber: | 7168875801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R026994-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6190467 | 01 | NY | INDEPEN. HEALTH PROV # | OTHER | 000590297001 | 01 | NY | BLUE CROSS PROV # | OTHER |