Provider Demographics
NPI:1447310263
Name:ROSENBERG, DORIE (LMFT)
Entity type:Individual
Prefix:MS
First Name:DORIE
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:DORIE
Other - Middle Name:NAOMI MALLIN
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:710 C ST STE 7C
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3891
Mailing Address - Country:US
Mailing Address - Phone:415-492-0656
Mailing Address - Fax:949-757-2536
Practice Address - Street 1:710 C ST STE 7C
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3891
Practice Address - Country:US
Practice Address - Phone:415-492-0656
Practice Address - Fax:949-757-2536
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN02R0OtherPROVIDER NUMBER