Healthcare Provider Details

I. General information

NPI: 1326332867
Provider Name (Legal Business Name): ELAINE L. ROSENBERG LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E DOTY ST STE 507
MADISON WI
53703-3397
US

IV. Provider business mailing address

10 E DOTY ST STE 507
MADISON WI
53703-3397
US

V. Phone/Fax

Practice location:
  • Phone: 805-699-5615
  • Fax: 608-251-3930
Mailing address:
  • Phone: 805-699-5615
  • Fax: 608-251-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1077-124
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number80617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: