Healthcare Provider Details

I. General information

NPI: 1568639276
Provider Name (Legal Business Name): DEBORAH ROSENBAUM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 03/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 GREAT PLAIN AVE
NEEDHAM MA
02492-2561
US

IV. Provider business mailing address

992 GREAT PLAIN AVE
NEEDHAM MA
02492-2561
US

V. Phone/Fax

Practice location:
  • Phone: 617-487-5357
  • Fax: 781-449-3134
Mailing address:
  • Phone: 617-487-5357
  • Fax: 781-449-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number68 017577
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number9163
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: