MEDICARE: MIRIAM BETH ROSENBERG LCSW

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	31733	MN
2	1041C0700X	Clinical Social Worker	150104778	IL

General Provider Information

NPI Number	:	1245836345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM BETH ROSENBERG LCSW

Provider Business Mailing Address
First Line	:	760 STILLWATER RD STE 101
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115-2060
Country	:	US
Telephone Number	:	651-800-1189
Fax Number	:

Provider Business Practice Location Address
First Line	:	760 STILLWATER RD STE 101
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115-2060
Country	:	US
Telephone Number	:	612-240-2369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2020
Last Update Date	:	02/04/2026

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