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General NPI Number Information
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NPI Number | 1891742987
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Entity Type | Organization
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Legal Business Name | DONALD L ROSE PSYD AND ASSOCIATES PA
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 5501 BAYVIEW DRIVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308
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Country | US
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Telephone | 954-941-4388
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Fax | 954-941-4389
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Provider Business Mailing Address
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Address Line | 6278 N FEDERAL HWY STE 29
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-1916
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Country | US
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Telephone | 954-941-4388
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Fax | 954-941-4389
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONALD L ROSE
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Credential | PSY. D.
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Telephone | 954-941-4388
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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 | PY0003878
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License Number State | FL
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