MEDICARE: ROSEMARY J. STAUBER, PHD

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	2-5325	TX

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	:	1164698841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEMARY J. STAUBER, PHD

Provider Business Mailing Address
First Line	:	359 E HILDEBRAND AVE
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-2436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 E HILDEBRAND AVE
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-2436
Country	:	US
Telephone Number	:	210-828-3624
Fax Number	:	219-828-2873

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. ROSEMARY J. STAUBER
Credential	:	PHD
Telephone Number	:	210-828-3624

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	05/02/2008

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