Healthcare Provider Details

I. General information

NPI: 1255417606
Provider Name (Legal Business Name): ELANA L. ROSENBAUM M.S.,M.S.W.L.I.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ROLLINGWOOD DR
WORCESTER MA
01609-1211
US

IV. Provider business mailing address

3 ROLLINGWOOD DR
WORCESTER MA
01609-1211
US

V. Phone/Fax

Practice location:
  • Phone: 508-756-1967
  • Fax: 508-756-0040
Mailing address:
  • Phone: 508-754-9357
  • Fax: 508-756-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100993-1
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: