Provider Demographics
NPI:1851443246
Name:ROSENBERG, ELLEN (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 COFFMAN ST STE 30
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5450
Mailing Address - Country:US
Mailing Address - Phone:303-245-4417
Mailing Address - Fax:303-245-4459
Practice Address - Street 1:529 COFFMAN ST STE 300
Practice Address - Street 2:MHCBBC
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5450
Practice Address - Country:US
Practice Address - Phone:303-245-4417
Practice Address - Fax:303-245-4459
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional