Healthcare Provider Details

I. General information

NPI: 1790858421
Provider Name (Legal Business Name): ROBIN S ROSENBERG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/05/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 UNION SQ W #1119
NEW YORK NY
10003-3306
US

IV. Provider business mailing address

5 UNION SQ W FRONT #1 #1119
NEW YORK NY
10003-3306
US

V. Phone/Fax

Practice location:
  • Phone: 650-440-5534
  • Fax:
Mailing address:
  • Phone: 650-440-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number4604
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 24085
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number021395
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10834698-2501
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4604
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 24085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: