Provider Demographics
NPI:1639401037
Name:ROMNESS ROSENBERG, KIRSTEN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:
Last Name:ROMNESS ROSENBERG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:ROMNESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2810 YOSEMITE AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1863
Mailing Address - Country:US
Mailing Address - Phone:612-716-5641
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE # B4
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-4352
Practice Address - Fax:612-904-4304
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN186611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical