| Johannarosenfield Llc | |
|
209 Cooper Ave Ste 5d Montclair NJ 07043-1850 | |
| (973) 457-8502 | |
| Not Available |
| Full Name | Johannarosenfield Llc |
|---|---|
| Speciality | Social Worker |
| Location | 209 Cooper Ave Ste 5d, Montclair, New Jersey |
| Authorized Official Name and Position | Johanna W Rosenfield (OWNER) |
| Authorized Official Contact | 9734578502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Johannarosenfield Llc Po Box 43611 Montclair NJ 07043-0611 Ph: () - | Johannarosenfield Llc 209 Cooper Ave Ste 5d Montclair NJ 07043-1850 Ph: (973) 457-8502 |
| NPI Number | 1578339925 |
|---|---|
| Provider Enumeration Date | 11/28/2023 |
| Last Update Date | 12/28/2023 |
| Certification Date | 12/28/2023 |
| Medicare PECOS PAC ID | 5294188413 |
|---|---|
| Medicare Enrollment ID | O20240124001680 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578339925 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Johanna W Rosenfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740645472 PECOS PAC ID: 5294064028 Enrollment ID: I20190904001557 |
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