Healthcare Provider Details

I. General information

NPI: 1245852300
Provider Name (Legal Business Name): ELIZA ROSBURG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

PO BOX 4215
AUBURN CA
95604-4215
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7623
  • Fax:
Mailing address:
  • Phone: 808-436-5120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116738
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904011498
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: