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NPI Code Detail

MEDICARE: AUDREY ANN ROSENBERG PHD

MEDICARE: AUDREY ANN ROSENBERG 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
1103T00000XPsychologistPSY15551CA

General Provider Information

NPI Number : 1952456386
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY ANN ROSENBERG PHD
Provider Business Mailing Address
First Line : 4501 ALLENDALE AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94619-2578
Country : US
Telephone Number : 510-269-9041
Fax Number : 510-269-9031
Provider Business Practice Location Address
First Line : 3301 E 12TH ST STE 259
Second Line :
City : OAKLAND
State : CA
Zip : 94601-2940
Country : US
Telephone Number : 510-269-9041
Fax Number : 510-269-9031
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/08/2007

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