Basic Information
| Provider Information | |||||||||
| NPI: | 1679141428 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENZWEIG | ||||||||
| FirstName: | ELEANOR | ||||||||
| MiddleName: | GLORIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, MSW | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 810 BEVERLEY DR APT 305 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229114607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345341501 | ||||||||
| FaxNumber: | 5052120332 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 BEVERLEY DR APT 305 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229114607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345341501 | ||||||||
| FaxNumber: | 5052120332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2021 | ||||||||
| LastUpdateDate: | 06/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | BBH-LCSW-LIC-4418 | MT | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | BBH-LCSW-LIL-4418 | 01 | MT | LICENSE | OTHER |