Provider Demographics
NPI:1992826317
Name:ROSENBAUM, MIREILLE (MSW)
Entity Type:Individual
Prefix:
First Name:MIREILLE
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 S FOREST DR
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2013
Mailing Address - Country:US
Mailing Address - Phone:201-836-7793
Mailing Address - Fax:201-287-9702
Practice Address - Street 1:658 S FOREST DR
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2013
Practice Address - Country:US
Practice Address - Phone:201-836-7793
Practice Address - Fax:201-287-9702
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001348001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical