MEDICARE: MICHAEL JACOB ROSENBERG LGSW

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	LG50082318	DC

General Provider Information

NPI Number	:	1922597178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JACOB ROSENBERG LGSW

Provider Business Mailing Address
First Line	:	1313 NEW YORK AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20005-4701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 NEW YORK AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20005-4701
Country	:	US
Telephone Number	:	202-795-7087
Fax Number	:

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

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	09/11/2019

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