Provider Demographics
NPI:1962624247
Name:ROSENBAUM, RUTH TINA (PHD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:TINA
Last Name:ROSENBAUM
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 1:200 W. 54TH ST.
Mailing Address - Street 2:8K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5504
Mailing Address - Country:US
Mailing Address - Phone:212-581-7061
Mailing Address - Fax:
Practice Address - Street 1:200 W. 54TH ST.
Practice Address - Street 2:8K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5504
Practice Address - Country:US
Practice Address - Phone:212-581-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000466102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst