MEDICARE: MRS. SHARON LOIS ROSEN RN, 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	163W00000X	Registered Nurse	4704084246	MI
2	1041C0700X	Clinical Social Worker	6801095676	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4704084246	OTHER	MI	RN LICENSE
2	6801095676	OTHER	MI	MASTER'S SOCIAL WORKER CLINICAL LICENSE

General Provider Information

NPI Number	:	1285061259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON LOIS ROSEN RN, LCSW

Provider Business Mailing Address
First Line	:	30538 FOX CLUB DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-1988
Country	:	US
Telephone Number	:	248-470-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	30538 FOX CLUB DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-1988
Country	:	US
Telephone Number	:	248-470-2111
Fax Number	:

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

Provider Enumeration Date	:	10/04/2013
Last Update Date	:	02/01/2021

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