Provider Demographics
NPI:1871190371
Name:ROSENBERG, MICHAEL (BS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 VERNON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6311
Mailing Address - Country:US
Mailing Address - Phone:916-782-1111
Mailing Address - Fax:
Practice Address - Street 1:1780 VERNON ST STE 1
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6311
Practice Address - Country:US
Practice Address - Phone:916-782-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor