Provider Demographics
NPI:1245406693
Name:ROSENBLUTH, MARION EISENDRATH (LCSW PHD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:EISENDRATH
Last Name:ROSENBLUTH
Suffix:
Gender:F
Credentials:LCSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 ST CLAIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-266-0757
Mailing Address - Fax:312-642-3814
Practice Address - Street 1:676 ST CLAIR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-266-0757
Practice Address - Fax:312-642-3814
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490048491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical