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NPI Code Detail

MEDICARE: MS. JEAN ROSENGARTEN DAVIDSON LCSW, LMFT

MEDICARE: MS. JEAN ROSENGARTEN DAVIDSON LCSW, LMFT
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
11041C0700XClinical Social Worker34000496AIN
2106H00000XMarriage & Family Therapist35000827AIN

General Provider Information

NPI Number : 1528049715
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JEAN ROSENGARTEN DAVIDSON LCSW, LMFT
Provider Business Mailing Address
First Line : 616 E. COLFAX AVENUE
Second Line :
City : SOUTH BEND
State : IN
Zip : 46617
Country : US
Telephone Number : 812-649-2936
Fax Number : 812-649-2936
Provider Business Practice Location Address
First Line : 616 E COLFAX AVE
Second Line :
City : SOUTH BEND
State : IN
Zip : 46617-2827
Country : US
Telephone Number : 574-261-1255
Fax Number : 574-289-7000
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 02/15/2013

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