MEDICARE: SANDRA LEE ROSENBACH

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	104100000X	Social Worker	22320	MD

General Provider Information

NPI Number	:	1669002317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LEE ROSENBACH

Provider Business Mailing Address
First Line	:	4710 PENNINGTON AVE FL 2
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21226-1405
Country	:	US
Telephone Number	:	917-816-6786
Fax Number	:

Provider Business Practice Location Address
First Line	:	4710 PENNINGTON AVE FL 2
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21226-1405
Country	:	US
Telephone Number	:	917-816-6786
Fax Number	:

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

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	01/22/2020

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Directions to “ SANDRA LEE ROSENBACH ” Practice Location

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