1861421463 NPI number — DR. SUSAN CAROL ROSENBLUTH PH.D.

Table of content: DR. SUSAN CAROL ROSENBLUTH PH.D. (NPI 1861421463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861421463 NPI number — DR. SUSAN CAROL ROSENBLUTH PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENBLUTH
Provider First Name:
SUSAN
Provider Middle Name:
CAROL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861421463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 N DOHENY DR
Provider Second Line Business Mailing Address:
#307
Provider Business Mailing Address City Name:
WEST HOLLYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90069-3172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-888-8749
Provider Business Mailing Address Fax Number:
310-388-5238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 N DOHENY DR
Provider Second Line Business Practice Location Address:
#307
Provider Business Practice Location Address City Name:
WEST HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90069-3172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-888-8749
Provider Business Practice Location Address Fax Number:
310-388-5238
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 20139 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 011986 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 011986 . This is a "CLINICAL PSYCHOLOGY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PSY 20139 . This is a "LICENSE IN CLINICAL PSYCH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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