MEDICARE: JESSICA ROSENBERG LCSW-R

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	73 033450	NY

General Provider Information

NPI Number	:	1871043745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ROSENBERG LCSW-R

Provider Business Mailing Address
First Line	:	328 4TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2805
Country	:	US
Telephone Number	:	917-399-5639
Fax Number	:

Provider Business Practice Location Address
First Line	:	7302 6TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2608
Country	:	US
Telephone Number	:	917-399-5639
Fax Number	:

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

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	10/04/2016

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