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General NPI Number Information
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NPI Number | 1093223265
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Entity Type | Organization
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Legal Business Name | LEIGH S. ROSENBERG, PSY.D. PLLC
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 01/22/2018
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Provider Practice Location Address
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Address Line | 2973 W SR 434 STE 400
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City | LONGWOOD
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State | FL
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Zip | 32779-4455
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Country | US
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Telephone | 407-362-5930
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Fax | 407-362-5930
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Provider Business Mailing Address
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Address Line | 2973 W SR 434 STE 400
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City | LONGWOOD
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State | FL
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Zip | 32779-4455
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Country | US
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Telephone | 407-362-5930
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Fax | 407-362-5930
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEIGH SCOTT ROSENBERG
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Credential | PSY.D.
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Telephone | 407-362-5930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0003608
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License Number State | FL
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