Provider Demographics
NPI:1255888939
Name:JOSIE ROSENBERG LLC
Entity type:Organization
Organization Name:JOSIE ROSENBERG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:646-209-9728
Mailing Address - Street 1:1221 W MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-3520
Mailing Address - Country:US
Mailing Address - Phone:646-209-9728
Mailing Address - Fax:
Practice Address - Street 1:19 OLD TOWN SQ
Practice Address - Street 2:UNIT 250M
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2471
Practice Address - Country:US
Practice Address - Phone:646-209-9728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001175106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty