Healthcare Provider Details

I. General information

NPI: 1558685909
Provider Name (Legal Business Name): CARYL H. ROSEN, PH.D. AND ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 COLUMBIA AVE STE 2F
MUNSTER IN
46321-3530
US

IV. Provider business mailing address

9250 COLUMBIA AVE STE 2F
MUNSTER IN
46321-3530
US

V. Phone/Fax

Practice location:
  • Phone: 219-201-0711
  • Fax: 219-836-6445
Mailing address:
  • Phone: 219-201-0711
  • Fax: 219-836-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CARYL H ROSEN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 219-201-0711