MEDICARE: STEPHEN J. ROSENBAUM MSW LCSW PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149-000569	IL

General Provider Information

NPI Number	:	1205247806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN J. ROSENBAUM MSW LCSW PC

Provider Business Mailing Address
First Line	:	1803 SAINT JOHNS AVE
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3298
Country	:	US
Telephone Number	:	847-432-2355
Fax Number	:

Provider Business Practice Location Address
First Line	:	1803 SAINT JOHNS AVE
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3298
Country	:	US
Telephone Number	:	847-432-2355
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEPHEN J ROSENBAUM
Credential	:	MSW
Telephone Number	:	847-432-2355

Provider Enumeration Date	:	05/16/2014
Last Update Date	:	05/16/2014

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