Provider Demographics
NPI:1558587329
Name:ROSENBERG, STACI (LCSW)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S GULFSTREAM AVE UNIT 14B
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-6744
Mailing Address - Country:US
Mailing Address - Phone:914-589-3588
Mailing Address - Fax:
Practice Address - Street 1:101 S GULFSTREAM AVE UNIT 14B
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-6744
Practice Address - Country:US
Practice Address - Phone:914-589-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0784941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical