Healthcare Provider Details

I. General information

NPI: 1558485425
Provider Name (Legal Business Name): DEENA ROSENBAUM L.I.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LINCOLN ST
NEWTON MA
02461-1527
US

IV. Provider business mailing address

57 FISHER AVE
NEWTON MA
02461-1142
US

V. Phone/Fax

Practice location:
  • Phone: 617-558-0216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1026460
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: