MEDICARE: MRS. LISA ROSENBAUM SW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1029562	MA

General Provider Information

NPI Number	:	1447247259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA ROSENBAUM SW

Provider Business Mailing Address
First Line	:	UNIT 3865
Second Line	:
City	:	APO
State	:	AE
Zip	:	09126
Country	:	DE
Telephone Number	:	4-965-6561
Fax Number	:	3183

Provider Business Practice Location Address
First Line	:	UNIT 3865
Second Line	:
City	:	APO
State	:	AE
Zip	:	09126
Country	:	DE
Telephone Number	:	4-965-6561
Fax Number	:	3183

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/08/2007

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Directions to “ MRS. LISA ROSENBAUM SW” Practice Location

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