MEDICARE: SARAH C. ROSENBAUM, PH.D., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS008962	PA

General Provider Information

NPI Number	:	1386910156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARAH C. ROSENBAUM, PH.D., LLC

Provider Business Mailing Address
First Line	:	323 CREST PARK RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1014
Country	:	US
Telephone Number	:	267-972-9001
Fax Number	:	215-844-5693

Provider Business Practice Location Address
First Line	:	101 GREENWOOD AVE
Second Line	:	SUITE 410
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-2627
Country	:	US
Telephone Number	:	267-972-9001
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. SARAH C ROSENBAUM
Credential	:	PH.D.
Telephone Number	:	267-972-9001

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	03/27/2012

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