Provider Demographics
NPI:1881212777
Name:ROSEWOOD, MICHAEL LEE (LMSW-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:ROSEWOOD
Suffix:
Gender:M
Credentials:LMSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36040 AVONDALE ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-8221
Mailing Address - Country:US
Mailing Address - Phone:989-415-1171
Mailing Address - Fax:734-506-1588
Practice Address - Street 1:36040 AVONDALE ST
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-8221
Practice Address - Country:US
Practice Address - Phone:989-415-1171
Practice Address - Fax:734-506-1588
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511102141041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical