Provider Demographics
NPI:1831478700
Name:ROSENFELD, JEFFREY MARC (MA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MARC
Last Name:ROSENFELD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 PARK COMMONS DR UNIT 407
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5219
Mailing Address - Country:US
Mailing Address - Phone:612-269-2810
Mailing Address - Fax:763-746-0843
Practice Address - Street 1:4730 PARK COMMONS DR UNIT 407
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5219
Practice Address - Country:US
Practice Address - Phone:612-269-2810
Practice Address - Fax:763-746-0843
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist