Provider Demographics
NPI:1972775849
Name:ROSENBERG, HAROLD (PHD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 EAST MERRY STREET BGSU
Mailing Address - Street 2:300 PSYCHOLOGY BUILDING, PSYCHOLOGICAL SERVICES CENTER
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43403-0232
Mailing Address - Country:US
Mailing Address - Phone:419-372-2540
Mailing Address - Fax:419-372-2533
Practice Address - Street 1:822 EAST MERRY STREET BGSU
Practice Address - Street 2:300 PSYCHOLOGY BUILDING, PSYCHOLOGICAL SERVICES CENTER
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43403-0232
Practice Address - Country:US
Practice Address - Phone:419-372-2540
Practice Address - Fax:419-372-2533
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4593103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0900056Medicaid
OH0900056Medicaid