Provider Demographics
NPI:1083756589
Name:ROSENBAUM, BETH RACHAEL (MSW LCSW ACSW)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:RACHAEL
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MSW LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6708 MC CALLUM ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119
Mailing Address - Country:US
Mailing Address - Phone:215-843-5672
Mailing Address - Fax:
Practice Address - Street 1:320 KING OF PRUSSIA RD
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-4440
Practice Address - Country:US
Practice Address - Phone:215-254-1580
Practice Address - Fax:215-487-3972
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW007606L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000008810009Medicaid
PA1000008810025OtherDEPT OF PUBLIC WELFARE ME