Provider Demographics
NPI:1811027527
Name:ROSENBERGER, JAMES STOTT (LISW-CP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:STOTT
Last Name:ROSENBERGER
Suffix:
Gender:M
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CALVARY HOME CIR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1002
Mailing Address - Country:US
Mailing Address - Phone:864-328-5187
Mailing Address - Fax:
Practice Address - Street 1:110 CALVARY HOME CIR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1002
Practice Address - Country:US
Practice Address - Phone:864-328-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7018104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1091Medicaid
SCGP1385Medicaid