Healthcare Provider Details

I. General information

NPI: 1821025800
Provider Name (Legal Business Name): JOEL ROSENBAUM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WHITWELL ST QUINCY MEDICAL CENTER, SUITE B618
QUINCY MA
02169-1870
US

IV. Provider business mailing address

36 HALVORSEN AVE
HULL MA
02045-2020
US

V. Phone/Fax

Practice location:
  • Phone: 617-376-2095
  • Fax: 617-376-5413
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number05087
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number05087
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number05087
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number05087
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number05087
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: