Provider Demographics
NPI:1588787600
Name:ROSENBERG, JOAN I (PHD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:I
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15173 MAGNOLIA BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1242
Mailing Address - Country:US
Mailing Address - Phone:818-205-9775
Mailing Address - Fax:
Practice Address - Street 1:1663 SAWTELLE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3191
Practice Address - Country:US
Practice Address - Phone:310-477-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 11108103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical