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General NPI Number Information
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NPI Number | 1427454636
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Entity Type | Individual
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Provider Name | MARC ROSENBERG BCBA, MFTI
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Gender | Male
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Dates
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Enumeration Date | 11/15/2014
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 3030 CALLE FRONTERA
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-3009
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Country | US
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Telephone | 818-577-7586
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Fax |
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Provider Business Mailing Address
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Address Line | 261 HILLCREST DR APT A
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City | ENCINITAS
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State | CA
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Zip | 92024-1584
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Country | US
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Telephone | 818-577-7586
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 74661
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-15-18144
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License Number State | CA
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