Provider Demographics
NPI:1881936656
Name:ROSENBERG, JUDITH ELISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ELISE
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 1:6928 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1830
Mailing Address - Country:US
Mailing Address - Phone:510-393-9277
Mailing Address - Fax:510-260-0117
Practice Address - Street 1:9933 MACARTHUR BLVD
Practice Address - Street 2:LIFELONG HOWARD DANIEL CLINIC
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605
Practice Address - Country:US
Practice Address - Phone:610-981-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 45511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical