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General NPI Number Information
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NPI Number | 1912292004
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Entity Type | Organization
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Legal Business Name | ELLIOTT B ROSENBAUM PSYD PA
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 4465 BAYMEADOWS RD SUITE 7
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City | JACKSONVILLE
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State | FL
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Zip | 32217-4732
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Country | US
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Telephone | 904-252-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 4465 BAYMEADOWS RD SUITE 7
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City | JACKSONVILLE
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State | FL
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Zip | 32217-4732
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ELLIOTT ROSENBAUM
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Credential | PSYD
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Telephone | 904-252-7979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PY8117
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License Number State | FL
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