MEDICARE: LAURA ROSENBAUM M.A. LPC

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	101Y00000X	Counselor	6401007278	MI

General Provider Information

NPI Number	:	1487701470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ROSENBAUM M.A. LPC

Provider Business Mailing Address
First Line	:	23091 REPUBLIC AVE
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-2346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 E 12 MILE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-2651
Country	:	US
Telephone Number	:	248-547-2223
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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