Provider Demographics
NPI:1134658990
Name:ROSENBERGER, ANDRAA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ANDRAA
Middle Name:
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 KANAWHA BLVD E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2115
Mailing Address - Country:US
Mailing Address - Phone:304-344-8515
Mailing Address - Fax:
Practice Address - Street 1:1111 VAN VOORHIS RD STE J
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2737
Practice Address - Country:US
Practice Address - Phone:304-212-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009439381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical