=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356643142
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT S ROSEN PHD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2010
-----------------------------------------------------
Last Update Date | 11/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1938 SOULE RD
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33759-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-726-7442
-----------------------------------------------------
Fax | 727-725-5537
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1938 SOULE ROAD
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-726-7442
-----------------------------------------------------
Fax | 727-725-5537
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. DEBORAH ROSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-726-7442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PY3696
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------