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General NPI Number Information
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NPI Number | 1275735656
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Entity Type | Individual
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Provider Name | JACOB C ROSIN M A LLP
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Gender | Male
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 10/28/2021
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Provider Practice Location Address
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Address Line | 409 PLYMOUTH RD STE 140
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City | PLYMOUTH
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State | MI
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Zip | 48170-1866
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Country | US
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Telephone | 248-514-6887
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Fax |
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Provider Business Mailing Address
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Address Line | 333 E 11 MILE RD APT 20
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City | ROYAL OAK
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State | MI
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Zip | 48067-2746
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Country | US
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Telephone | 248-514-6887
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6361002793
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License Number State | MI
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