Provider Demographics
NPI:1821295486
Name:ROSENZWEIG, MITCHELL J
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:J
Last Name:ROSENZWEIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT DEPOSIT
Mailing Address - State:MD
Mailing Address - Zip Code:21904-1726
Mailing Address - Country:US
Mailing Address - Phone:667-441-0955
Mailing Address - Fax:
Practice Address - Street 1:2501 MACHINE ST
Practice Address - Street 2:STE 306
Practice Address - City:ABERDEEN PROVING GROUNDS
Practice Address - State:MD
Practice Address - Zip Code:21005
Practice Address - Country:US
Practice Address - Phone:667-441-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 605764291041C0700X
MI68010605471041C0700X
NH16501041C0700X
CALCSW922251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical