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General NPI Number Information
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NPI Number | 1780057141
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Entity Type | Organization
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Legal Business Name | EMJAR LLC
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Dates
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Enumeration Date | 11/07/2015
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 401 BROADWAY SUITE 305
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City | TACOMA
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State | WA
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Zip | 98402-3900
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Country | US
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Telephone | 253-656-6676
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Fax |
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Provider Business Mailing Address
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Address Line | 401 BROADWAY SUITE 305
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City | TACOMA
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State | WA
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Zip | 98402-3900
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MITCHELL ROSENZWEIG
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Credential | LICSW
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Telephone | 253-656-6676
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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 | LW 60576429
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License Number State | WA
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