Provider Demographics
NPI:1386792554
Name:ROSEN, MICHAEL RODNEY (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RODNEY
Last Name:ROSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 ED DR STE 108
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8092
Mailing Address - Country:US
Mailing Address - Phone:919-324-3385
Mailing Address - Fax:919-324-3404
Practice Address - Street 1:4041 ED DR STE 108
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8092
Practice Address - Country:US
Practice Address - Phone:919-324-3385
Practice Address - Fax:919-324-3404
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW35711041C0700X
NCC009855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6663AMedicare ID - Type Unspecified