Provider Demographics
NPI:1962015388
Name:ROSEBERRY, SONYA
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:ROSEBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27750 LEXINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7405
Mailing Address - Country:US
Mailing Address - Phone:248-259-5267
Mailing Address - Fax:
Practice Address - Street 1:27750 LEXINGTON PKWY
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-7405
Practice Address - Country:US
Practice Address - Phone:248-259-5267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382849658Medicaid