MEDICARE: DR. RACHEL MANN-ROSAN 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	016353	NY
2	103TM1800X	Intellectual & Developmental Disabilities Psychologist	016353	NY

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	:	1720224330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL MANN-ROSAN PH.D.

Provider Business Mailing Address
First Line	:	461 GRAND AVE
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-6109
Country	:	US
Telephone Number	:	518-926-0037
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 MAPLE DELL
Second Line	:	SUITE 3
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2951
Country	:	US
Telephone Number	:	518-926-0037
Fax Number	:

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

Provider Enumeration Date	:	01/02/2009
Last Update Date	:	07/20/2009

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