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General NPI Number Information
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NPI Number | 1073152898
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Entity Type | Individual
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Provider Name | AVIVA ROSENBERG LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/26/2019
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Last Update Date | 12/26/2019
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Provider Practice Location Address
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Address Line | 2754 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60647-6870
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Country | US
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Telephone | 312-762-2749
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Fax |
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Provider Business Mailing Address
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Address Line | 655 W IRVING PARK RD APT 5514
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City | CHICAGO
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State | IL
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Zip | 60613-6311
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Country | US
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Telephone | 973-715-6450
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 149.021661
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License Number State | IL
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