Healthcare Provider Details

I. General information

NPI: 1982635512
Provider Name (Legal Business Name): HELEN P. ROSENBERG-WAKS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4054 MCKINNEY AVE STE 102
DALLAS TX
75204-2050
US

IV. Provider business mailing address

4054 MCKINNEY AVE STE 102
DALLAS TX
75204-2050
US

V. Phone/Fax

Practice location:
  • Phone: 214-520-6308
  • Fax: 214-521-9172
Mailing address:
  • Phone: 214-520-6308
  • Fax: 214-521-9172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30462
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: