Healthcare Provider Details

I. General information

NPI: 1720558141
Provider Name (Legal Business Name): NICHOLAS ROSENBERG LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S CHAPEL GATE LN
BALTIMORE MD
21229-3906
US

IV. Provider business mailing address

2354 COBBLE HILL TER
WHEATON MD
20902-7625
US

V. Phone/Fax

Practice location:
  • Phone: 410-368-7800
  • Fax:
Mailing address:
  • Phone: 443-300-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number32083
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: