Provider Demographics
NPI:1831897099
Name:ROSENBERG, SUZANNAH (LCSW)
Entity type:Individual
Prefix:
First Name:SUZANNAH
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4003
Mailing Address - Country:US
Mailing Address - Phone:269-271-5852
Mailing Address - Fax:
Practice Address - Street 1:2311 COTTMAN AVE STE 71
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1007
Practice Address - Country:US
Practice Address - Phone:215-444-7505
Practice Address - Fax:215-695-2919
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0222061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical