Provider Demographics
NPI:1972637254
Name:PAINES ROSENBERG THERAPY, P.C.
Entity type:Organization
Organization Name:PAINES ROSENBERG THERAPY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:301-540-4452
Mailing Address - Street 1:12512 W OLD BALTIMORE RD
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-9010
Mailing Address - Country:US
Mailing Address - Phone:301-540-4452
Mailing Address - Fax:301-540-4453
Practice Address - Street 1:12512 W OLD BALTIMORE RD
Practice Address - Street 2:
Practice Address - City:BOYDS
Practice Address - State:MD
Practice Address - Zip Code:20841-9010
Practice Address - Country:US
Practice Address - Phone:301-540-4452
Practice Address - Fax:301-540-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419872700Medicaid
MD589676AE5QOtherMEDICARE