Provider Demographics
NPI:1902989494
Name:ROSENBERG, MATTHEW DAVID (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DAVID
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31201 CHICAGO RD S
Mailing Address - Street 2:SUITE A102
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5527
Mailing Address - Country:US
Mailing Address - Phone:586-275-0657
Mailing Address - Fax:586-275-0723
Practice Address - Street 1:31201 CHICAGO RD S
Practice Address - Street 2:SUITE A102
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5527
Practice Address - Country:US
Practice Address - Phone:586-275-0657
Practice Address - Fax:586-275-0723
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010692661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical