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General NPI Number Information
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NPI Number | 1952456386
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Entity Type | Individual
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Provider Name | AUDREY ANN ROSENBERG PHD
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3301 E 12TH ST STE 259
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City | OAKLAND
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State | CA
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Zip | 94601-2940
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Country | US
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Telephone | 510-269-9041
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Fax | 510-269-9031
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Provider Business Mailing Address
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Address Line | 4501 ALLENDALE AVE
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City | OAKLAND
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State | CA
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Zip | 94619-2578
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Country | US
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Telephone | 510-269-9041
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Fax | 510-269-9031
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY15551
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License Number State | CA
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