MEDICARE: MS. ALICE K. ROSEBERRY LISW

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	I-0002952	OH

General Provider Information

NPI Number	:	1710942289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICE K. ROSEBERRY LISW

Provider Business Mailing Address
First Line	:	3740 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-1354
Country	:	US
Telephone Number	:	513-354-5693
Fax Number	:	513-921-8222

Provider Business Practice Location Address
First Line	:	3740 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-1354
Country	:	US
Telephone Number	:	513-354-5693
Fax Number	:	513-921-8222

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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