Healthcare Provider Details

I. General information

NPI: 1912594466
Provider Name (Legal Business Name): ELAINE ROSENBERG, LMFT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2020
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 Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ELAINE L ROSENBERG
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LMFT
Phone: 805-699-5615