Provider Demographics
NPI:1316197130
Name:ROSEN, ALLYSON C (PHD, ABPP-CN)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:C
Last Name:ROSEN
Suffix:
Gender:F
Credentials:PHD, ABPP-CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 GARLAND DR
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3605
Mailing Address - Country:US
Mailing Address - Phone:650-279-3949
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE # 151Y
Practice Address - Street 2:PALO ALTO VA MEDICAL CENTER
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17777103G00000X, 103TA0700X, 103TC0700X
WI1975-057103G00000X, 103TA0700X, 103TC0700X
MA7083103G00000X, 103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical