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General NPI Number Information
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NPI Number | 1306900246
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Entity Type | Individual
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Provider Name | RICHARD J ROSENBLUM PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1899 MISSION ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-3501
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Country | US
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Telephone | 415-934-3442
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Fax | 415-626-9263
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Provider Business Mailing Address
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Address Line | 1621 DELAWARE ST
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City | BERKELEY
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State | CA
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Zip | 94703-1210
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Country | US
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Telephone | 510-848-1629
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY21106
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License Number State | CA
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