Provider Demographics
NPI:1447603618
Name:ROSENBERG, ALICIA JEAN (LCPC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:JEAN
Last Name:ROSENBERG
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 1:1165 N CLARK ST STE 305
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7862
Mailing Address - Country:US
Mailing Address - Phone:312-880-9913
Mailing Address - Fax:844-787-9891
Practice Address - Street 1:1165 N CLARK ST STE 305
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7862
Practice Address - Country:US
Practice Address - Phone:312-880-9913
Practice Address - Fax:844-787-9891
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional