1508095969 NPI number — MS. ALISON ROSEN B.IND PSYCH LMT CMT

Table of content: MS. ALISON ROSEN B.IND PSYCH LMT CMT (NPI 1508095969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508095969 NPI number — MS. ALISON ROSEN B.IND PSYCH LMT CMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSEN
Provider First Name:
ALISON
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
B.IND PSYCH LMT CMT
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:
1508095969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE HUGHES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93532-0406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-435-3142
Provider Business Mailing Address Fax Number:
267-948-5144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42505 RANCH CLUB ROAD
Provider Second Line Business Practice Location Address:
LAKE ELIZABETH GOLF AND RANCH CLUB
Provider Business Practice Location Address City Name:
ELIZABETH LAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-435-3142
Provider Business Practice Location Address Fax Number:
267-948-5144
Provider Enumeration Date:
07/07/2009

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: 225700000X , with the licence number:  10010915 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com