Healthcare Provider Details

I. General information

NPI: 1851460968
Provider Name (Legal Business Name): CARYL H. ROSEN CARYL H.ROSEN, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
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
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 TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071005821
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY9548
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20041300A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: