Provider Demographics
NPI:1962700633
Name:ROSENBAUM, DEISSY YASMIN (MA)
Entity type:Individual
Prefix:MRS
First Name:DEISSY
Middle Name:YASMIN
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660253
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-7253
Mailing Address - Country:US
Mailing Address - Phone:512-649-2270
Mailing Address - Fax:512-727-0476
Practice Address - Street 1:345 CYPRESS CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4484
Practice Address - Country:US
Practice Address - Phone:512-842-5168
Practice Address - Fax:512-727-0476
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1702880509225400000X
TX203645106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner