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General NPI Number Information
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NPI Number | 1063751790
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Entity Type | Individual
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Provider Name | ROSETTA MARIA DELOOF-PRIMMER LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 450 SAINT JOHN RD
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-7354
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Country | US
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Telephone | 219-879-0676
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Fax |
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Provider Business Mailing Address
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Address Line | 8239 E WALNUT RDG
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City | NEW CARLISLE
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State | IN
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Zip | 46552-9075
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Country | US
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Telephone | 574-276-9571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 34006887A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33006230A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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