Provider Demographics
NPI:1548753007
Name:ROSENBERG, M. SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:M.
Middle Name:SUSAN
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARYSUSAN
Other - Middle Name:CUDA
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5924 ROYAL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3863
Mailing Address - Country:US
Mailing Address - Phone:214-957-1002
Mailing Address - Fax:
Practice Address - Street 1:5924 ROYAL LN STE 211
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-7892
Practice Address - Country:US
Practice Address - Phone:214-957-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical