MEDICARE: MARSHA ROSENSTEIN 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	44SC05270100	NJ

General Provider Information

NPI Number	:	1588772172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA ROSENSTEIN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 15
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-0015
Country	:	US
Telephone Number	:	732-583-7987
Fax Number	:	732-583-7987

Provider Business Practice Location Address
First Line	:	3350 STATE ROUTE 138
Second Line	:	AUTUMN RIDGE BUILDING 2, SUITE 128
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9693
Country	:	US
Telephone Number	:	732-583-7987
Fax Number	:	732-583-7987

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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