Provider Demographics
NPI:1689697583
Name:ROSENSTOCK, JANET LYNN (MSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:ROSENSTOCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 N ALVERNON WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1500
Mailing Address - Country:US
Mailing Address - Phone:520-795-2396
Mailing Address - Fax:520-795-2069
Practice Address - Street 1:2802 N ALVERNON WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1500
Practice Address - Country:US
Practice Address - Phone:520-795-2396
Practice Address - Fax:520-795-2069
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-00641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S26960Medicare UPIN
AZZCSW64IMedicare ID - Type UnspecifiedPROVIDER NUMBER