MEDICARE: DANIEL J ROSENBAUM PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	3323	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154381127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL J ROSENBAUM PH.D.

Provider Business Mailing Address
First Line	:	1441 N 12TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2837
Country	:	US
Telephone Number	:	602-495-4577
Fax Number	:	602-417-3549

Provider Business Practice Location Address
First Line	:	1012 E WILLETTA ST
Second Line	:	3RD FLOOR AND 5TH FLOOR
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2749
Country	:	US
Telephone Number	:	602-239-2361
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	06/22/2011

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