Provider Demographics
NPI:1275674954
Name:ROSENSTEIN, MARYLEE (LCPC)
Entity type:Individual
Prefix:
First Name:MARYLEE
Middle Name:
Last Name:ROSENSTEIN
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:MARYLEE
Other - Middle Name:
Other - Last Name:BENNISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:70 NE FARGO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2019
Mailing Address - Country:US
Mailing Address - Phone:207-415-0055
Mailing Address - Fax:888-765-8406
Practice Address - Street 1:70 NE FARGO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2019
Practice Address - Country:US
Practice Address - Phone:207-415-0055
Practice Address - Fax:888-765-8406
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC8901101YP2500X
MECC3487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432457199Medicaid