Healthcare Provider Details

I. General information

NPI: 1861569162
Provider Name (Legal Business Name): SANFORD ROSENZWEIG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CAMERON RD
WAYLAND MA
01778-3101
US

IV. Provider business mailing address

17 CAMERON RD
WAYLAND MA
01778-3101
US

V. Phone/Fax

Practice location:
  • Phone: 508-358-5918
  • Fax: 309-419-7419
Mailing address:
  • Phone: 508-358-5918
  • Fax: 309-419-7419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number926
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: