Healthcare Provider Details

I. General information

NPI: 1841291879
Provider Name (Legal Business Name): KATHRYN MARGARET ROSENBAUM LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 EAST 84 PL
MERRILLVILLE IN
46410
US

IV. Provider business mailing address

8400 LOUISIANNA ST
MERRILLVILLE IN
46410
US

V. Phone/Fax

Practice location:
  • Phone: 219-794-2000
  • Fax: 219-794-2010
Mailing address:
  • Phone: 219-757-1928
  • Fax: 219-757-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39000721A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: