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General NPI Number Information
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NPI Number | 1679793418
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Entity Type | Individual
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Provider Name | MINDY SUSAN ROSENBERG PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1505 BRIDGEWAY STE 105
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City | SAUSALITO
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State | CA
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Zip | 94965-1967
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Country | US
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Telephone | 415-491-1879
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Fax | 415-869-5300
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Provider Business Mailing Address
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Address Line | 1505 BRIDGEWAY STE 105
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City | SAUSALITO
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State | CA
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Zip | 94965-1967
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Country | US
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Telephone | 415-491-1879
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Fax | 415-869-5300
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY11015
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY11015
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY11015
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License Number State | CA
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