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NPI Code Detail

MEDICARE: DR. DIANE NAOMI ROSENBAUM PH.D.

MEDICARE: DR. DIANE NAOMI 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
1103TC0700XClinical Psychologist71-3093IL

General Provider Information

NPI Number : 1326059809
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANE NAOMI ROSENBAUM PH.D.
Provider Business Mailing Address
First Line : 545 CHEROKEE RD
Second Line :
City : HIGHLAND PARK
State : IL
Zip : 60035-5262
Country : US
Telephone Number : 847-926-8510
Fax Number : 847-926-9755
Provider Business Practice Location Address
First Line : 2835 N SHEFFIELD AVE
Second Line : SUITE 312
City : CHICAGO
State : IL
Zip : 60657-5081
Country : US
Telephone Number : 773-880-2214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 07/08/2007

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