=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790027225
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH ROSNER PH.D. A PSYCHOLOGICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2013
-----------------------------------------------------
Last Update Date | 03/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 578 LORNA LN
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90049-4215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-476-8004
-----------------------------------------------------
Fax | 310-476-6376
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 578 LORNA LN
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90049-4215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-476-8004
-----------------------------------------------------
Fax | 310-476-6376
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOSEPH ROSNER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 310-477-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TB0200X
-----------------------------------------------------
Taxonomy Name | Cognitive & Behavioral Psychologist
-----------------------------------------------------
License Number | PSY2430
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------