MEDICARE: SHANNON ROSENBERG

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	92279	CA

General Provider Information

NPI Number	:	1255744058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON ROSENBERG

Provider Business Mailing Address
First Line	:	PO BOX 102
Second Line	:
City	:	NIWOT
State	:	CO
Zip	:	80544-0102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 WHITBY RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-4734
Country	:	US
Telephone Number	:	804-852-2477
Fax Number	:

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

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	06/23/2026

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Directions to “ SHANNON ROSENBERG ” Practice Location

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