Provider Demographics
NPI:1093223265
Name:LEIGH S. ROSENBERG, PSY.D. PLLC
Entity type:Organization
Organization Name:LEIGH S. ROSENBERG, PSY.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-362-5930
Mailing Address - Street 1:2973 W SR 434 STE 400
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4455
Mailing Address - Country:US
Mailing Address - Phone:407-362-5930
Mailing Address - Fax:407-362-5930
Practice Address - Street 1:2973 W SR 434 STE 400
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4455
Practice Address - Country:US
Practice Address - Phone:407-362-5930
Practice Address - Fax:407-362-5930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003608103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty