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General NPI Number Information
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NPI Number | 1245852300
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Entity Type | Individual
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Provider Name | ELIZA ROSBURG LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 5342 DUDLEY BLVD
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City | MCCLELLAN
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State | CA
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Zip | 95652-1012
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Country | US
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Telephone | 916-561-7623
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4215
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City | AUBURN
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State | CA
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Zip | 95604-4215
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Country | US
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Telephone | 808-436-5120
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 116738
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904011498
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License Number State | VA
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