Provider Demographics
NPI:1891388336
Name:ROSENBERG, LEE
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:ROSENBERG
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 1:103 W US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49968-9515
Mailing Address - Country:US
Mailing Address - Phone:906-229-6120
Mailing Address - Fax:906-229-6191
Practice Address - Street 1:103 W US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MI
Practice Address - Zip Code:49968-9515
Practice Address - Country:US
Practice Address - Phone:906-229-6120
Practice Address - Fax:906-229-6191
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802091074104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker