Provider Demographics
NPI:1346261815
Name:ROSENBERG, AILEEN FELICE (MSW/LCSW)
Entity Type:Individual
Prefix:MS
First Name:AILEEN
Middle Name:FELICE
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W BITTERSWEET PL
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2309
Mailing Address - Country:US
Mailing Address - Phone:773-484-6672
Mailing Address - Fax:773-279-2789
Practice Address - Street 1:4755 N KENMORE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5015
Practice Address - Country:US
Practice Address - Phone:773-262-6892
Practice Address - Fax:773-279-2789
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490101631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208767Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER