Healthcare Provider Details

I. General information

NPI: 1003180761
Provider Name (Legal Business Name): PAMELA J ROSENBERG LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 WASHINGTON ST
RALEIGH NC
27605-1255
US

IV. Provider business mailing address

867 WASHINGTON ST
RALEIGH NC
27605-1255
US

V. Phone/Fax

Practice location:
  • Phone: 919-833-5867
  • Fax: 919-833-5859
Mailing address:
  • Phone: 919-833-5867
  • Fax: 919-833-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCOO4636
License Number StateNC

VIII. Authorized Official

Name: MRS. PAMELA J ROSENBERG
Title or Position: LCSW
Credential: MSW
Phone: 919-833-5867