MEDICARE: MS. ROSE MARIE LICHTENFELS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW-2477	AZ

General Provider Information

NPI Number	:	1144483934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSE MARIE LICHTENFELS LCSW

Provider Business Mailing Address
First Line	:	4208 E JUANITA AVE
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-0350
Country	:	US
Telephone Number	:	480-347-8136
Fax Number	:

Provider Business Practice Location Address
First Line	:	4111 E VALLEY AUTO DR
Second Line	:	SUITE 201
City	:	MESA
State	:	AZ
Zip	:	85206-4605
Country	:	US
Telephone Number	:	480-347-8136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	02/23/2009

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