Individual provider Active NPI

Elana L. Rosenbaum, M.S.,M.S.W.L.I.C.S.W

  • Clinical Social Worker
  • Worcester, MA
National Provider Identifier
1255417606
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
100993-1 Issued in MA
Practice address
3 Rollingwood Dr
Worcester, MA 01609-1211
Phone
(508) 756-1967
Fax
(508) 756-0040
NPI assigned
Oct 28, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 100993-1 MA Primary

Addresses

Primary practice location

3 Rollingwood Dr
Worcester, MA 01609-1211

Mailing address

3 Rollingwood Dr
Worcester, MA 01609-1211
Phone (508) 754-9357

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050923000096 MA Practitioner - Clinical Social Worker 5395779821 Practice locations: Worcester, MA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
100993-1MAMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255417606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 ROLLINGWOOD DR",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091211",
            "telephone_number": "508-754-9357",
            "fax_number": "508-756-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 ROLLINGWOOD DR",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091211",
            "telephone_number": "508-756-1967",
            "fax_number": "508-756-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBAUM",
        "first_name": "ELANA",
        "middle_name": "L.",
        "name_prefix": "Ms.",
        "credential": "M.S.,M.S.W.L.I.C.S.W",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "100993-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.