Healthcare Provider Details

I. General information

NPI: 1841766987
Provider Name (Legal Business Name): DANA ROSEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date: 04/06/2021
Reactivation Date: 07/22/2021

III. Provider practice location address

167 POINT ST
PROVIDENCE RI
02903-4771
US

IV. Provider business mailing address

1040 GREAT PLAIN AVE STE 312
NEEDHAM MA
02492-2500
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-8808
  • Fax:
Mailing address:
  • Phone: 724-612-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01982
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: