Provider Demographics
NPI:1891742987
Name:DONALD L ROSE PSYD AND ASSOCIATES PA
Entity type:Organization
Organization Name:DONALD L ROSE PSYD AND ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:954-941-4388
Mailing Address - Street 1:6278 N FEDERAL HWY STE 29
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1916
Mailing Address - Country:US
Mailing Address - Phone:954-941-4388
Mailing Address - Fax:954-941-4389
Practice Address - Street 1:5501 BAYVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-941-4388
Practice Address - Fax:954-941-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003878103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1063461127OtherINDIVIDUAL NPI
FLK9846OtherGROUP
FLPY0003878OtherSTATE LICENSE
FL1891742987OtherGROUP NPI
FLK9846OtherGROUP
FL1063461127OtherINDIVIDUAL NPI