Healthcare Provider Details

I. General information

NPI: 1730100231
Provider Name (Legal Business Name): JEAN A ROSENFELD M.S.W., LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 RIVER OAK WAY
CARMICHAEL CA
95608-5560
US

IV. Provider business mailing address

5730 RIVER OAK WAY
CARMICHAEL CA
95608-5560
US

V. Phone/Fax

Practice location:
  • Phone: 916-487-8276
  • Fax: 916-487-8276
Mailing address:
  • Phone: 916-487-8276
  • Fax: 916-487-8276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS12056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: