Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 149.006868 | IL |
NPI | 1003030370 |
---|---|
Provider Name | Mr. Greg Rosen |
First Address | Chicago, IL 60615-4557 |
Second Address | Chicago, IL 60615-4557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 03/03/2011 |