MEDICARE: MR. MATTHEW DAVID ROSENBERG LMSW

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	6801069266	MI

General Provider Information

NPI Number	:	1902989494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW DAVID ROSENBERG LMSW

Provider Business Mailing Address
First Line	:	31201 CHICAGO RD S
Second Line	:	SUITE A102
City	:	WARREN
State	:	MI
Zip	:	48093-5527
Country	:	US
Telephone Number	:	586-275-0657
Fax Number	:	586-275-0723

Provider Business Practice Location Address
First Line	:	31201 CHICAGO RD S
Second Line	:	SUITE A102
City	:	WARREN
State	:	MI
Zip	:	48093-5527
Country	:	US
Telephone Number	:	586-275-0657
Fax Number	:	586-275-0723

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	03/05/2013

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