Healthcare Provider Details

I. General information

NPI: 1861821688
Provider Name (Legal Business Name): DORI E ROSENBERG PHD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 N 45TH ST SUITE 200
SEATTLE WA
98103-6741
US

IV. Provider business mailing address

5224 S PEARL ST
SEATTLE WA
98118-2148
US

V. Phone/Fax

Practice location:
  • Phone: 206-420-4701
  • Fax: 206-420-4841
Mailing address:
  • Phone: 858-361-9256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60244270
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY60244270
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: