Healthcare Provider Details

I. General information

NPI: 1467512517
Provider Name (Legal Business Name): CARY DENNIS ROSTOW PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 COLONIAL DR
BATON ROUGE LA
70806-6511
US

IV. Provider business mailing address

740 COLONIAL DR
BATON ROUGE LA
70806-6511
US

V. Phone/Fax

Practice location:
  • Phone: 225-216-9422
  • Fax: 225-216-1260
Mailing address:
  • Phone: 225-216-9422
  • Fax: 225-216-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number278MP
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number278MP
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: