Provider Demographics
NPI:1427454636
Name:ROSENBERG, MARC (BCBA, MFTI)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:BCBA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 HILLCREST DR APT A
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1584
Mailing Address - Country:US
Mailing Address - Phone:818-577-7586
Mailing Address - Fax:
Practice Address - Street 1:3030 CALLE FRONTERA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-3009
Practice Address - Country:US
Practice Address - Phone:818-577-7586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-15
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74661106H00000X
CA1-15-18144103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist