Healthcare Provider Details

I. General information

NPI: 1134171861
Provider Name (Legal Business Name): HAROLD D ROSENHEIM PH.D.. LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MEDICAL CENTER
FARGO ND
58102
US

IV. Provider business mailing address

3145 9 1/2 ST N
FARGO ND
58102-1302
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3700
  • Fax: 701-271-2969
Mailing address:
  • Phone: 701-239-3700
  • Fax: 701-271-2969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1239
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number124
License Number StateND

VII. Legacy identifiers

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

# 1
Identifier1239
Identifier TypeOTHER
Identifier StateND
Identifier IssuerADDICTION COUNSELING LIC.
# 2
Identifier124
Identifier TypeOTHER
Identifier StateND
Identifier IssuerPSYCHOLOGY LICENSE
# 3
Identifier25273
Identifier TypeOTHER
Identifier StateND
Identifier IssuerHEALTH SERVICES REGISTER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: