Provider Demographics
NPI:1922358894
Name:ROSENBERG, JENNIFER ROSE (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ROSE
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 SHATTUCK RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2329
Mailing Address - Country:US
Mailing Address - Phone:989-752-7867
Mailing Address - Fax:989-752-6830
Practice Address - Street 1:508 SHATTUCK RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2329
Practice Address - Country:US
Practice Address - Phone:989-752-7867
Practice Address - Fax:989-752-6830
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094420104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801094420OtherCLINICAL LICENSE