Provider Demographics
NPI:1174938419
Name:ROSENMAYER, MIRANDA (LCPC)
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:
Last Name:ROSENMAYER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 DEER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5513
Mailing Address - Country:US
Mailing Address - Phone:815-546-4277
Mailing Address - Fax:
Practice Address - Street 1:1382 DEER CREEK LN
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5513
Practice Address - Country:US
Practice Address - Phone:815-546-4277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005058101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health