MEDICARE: DR. ANNA BETH ROSEN 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	011308-1	NY

General Provider Information

NPI Number	:	1417154196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA BETH ROSEN PH.D.

Provider Business Mailing Address
First Line	:	33 MARION AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12203-1822
Country	:	US
Telephone Number	:	518-438-5899
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 HAMILTON ST
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12210-1707
Country	:	US
Telephone Number	:	518-427-8313
Fax Number	:

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	07/08/2007

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